54 yr male with trauma history of ankylosis same knee following septic arthritis at 16 yrs of age,diabetes controlled by dietnot willing for tkr as he had thought about it becos of ankylosis earlier and firm on that decision,no pain previously,office job
Questions for academic interestShould patella be fixed?
Timing of tkr whether now or when?What all Technical difficultis during surg?How is outlook after tkr?
May I answer the first immediate question.
ReplyDeleteI would fix the patella percutaneously with 2 cannulated screws thru with a tension band wire. Scope and IMI with a patellar clamp percutaneously and fine tune reduction if needed to improve with scope. Brace for 6 weeks.
TKR if needed definetily later.
Jacob
as the knee is ankylosed , an intact quadriceps should act basically as a hip flexor which wont be much of an use. so unless patient has severe complaint of pain due to fracture i dont think patella has to be fixed. as far as TKR goes im not sure how functional the quadriceps mechanism will be in a knee thats been ankylosed for 30 yrs and of course he is not going to have a painfull knee as its ankylosed
ReplyDeletesir, does it need to be braced after TBW when knee is ankylosed?..
ReplyDeleteJacob Hi This is Thampy. Immediate problem patella best fixed although I will be aiming to get union and not for perfection of reduction. Will do open, TBW not strictly needed as there is no movement at the knee.
ReplyDeleteTKR I would resist the temptation so long as the patient is not demanding mobility considering the problems that he could run into.
if the aim of fixing patella is to obtain better bone stock for future TKA, i would agree with Jacob. If patient is so sure of not having TKA, then why subject him to surgery?
ReplyDeleteIf he wanted TKR, i would suggest 2 stage, first fix patella, and later after consolidation of fracture union (May be 1 yr), second stage TKR , bcoz the PF forces are high after TKR for ankylosed knee. Outcomes are functionally favourable.