A 68-year-old woman has been suffering from mechanical bilateral knee pain for the past 6 years. The x-rays reveal complex right knee arthritis with ligament deficiency. How would you classify it and how would you manage this condition?
- 68 y.o. woman,
- Mechanical bilateral knee pain for 6 years
- Walking perimeter: 40m with a walker
Physical examination
- 1m45, 95kg
- 0/0/ 130°
- Bilateral varus deformity
- Lateral and postero-lateral instability
- Medial femorotibial pain
Right knee X-rays
How would you classify this arthritis?
- ✔️Kellgren and Lawrence grade 4
- ✔️Ahlback grade 4
Seeing the posterior cup, what other exams would you do?
- ✔️3D planning thanks to a CT scan
- ✔️X-ray telemetry of the lower limbs
How would you manage this condition?
- ✔️Hinged TKA
In case of severe ligament laxity, a Hinged TKA should be used. In some cases with less severe deformity, a constrained TKA can be implanted.
Final strategic decision
The final strategy was to plan the tibial cut thanks to a custom-made guide (Prophecy Evolution, MICROPORT) and implant a Hinged TKA.
Pre operative planification
Post-operative X-Rays
Clinical presentation 2 months post-op
The patient is painless, she has a walking perimeter of 1 km with 2 crouches because of left knee pain, and her range of motion is 0/0/110.
Comments
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thank you for the case.(No subject)
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good job