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. 2024 Dec 18;145(1):63.
doi: 10.1007/s00402-024-05708-5.

Total knee arthroplasty in patient with poliomyelitis sequelae: maintaining a recurvatum is associated with better mid-term functional results

Grégoire Rougereau  1   2 , Bernard Hollier-Larousse  3 , Vincent Carpentier  4   5   6 , Thomas Bauer  7 , François Genêt  4   5   6 , Marjorie Salga  4   5   6 , Fabien Cale  3
Affiliations

Total knee arthroplasty in patient with poliomyelitis sequelae: maintaining a recurvatum is associated with better mid-term functional results

Grégoire Rougereau et al. Arch Orthop Trauma Surg. .

Abstract

Purpose: Total knee arthroplasty (TKA) in patients with sequelae of poliomyelitis is a surgical challenge due to muscle weakness, bone deformities or post-polio syndrome (PPS). Few data exist to determine the factors contributing to poor functional results. This study aimed: (1) to describe a cohort of patients with poliomyelitis sequelae who underwent TKA; (2) to examine risk factors for poor functional outcome.

Methods: A monocentric retrospective cohort study of all patients with poliomyelitis sequelae who underwent TKA between January 2006 and December 2019. Clinical, functional outcomes, radiographic results and occurrence of complications were collected.

Results: A total of 22 patients (24 knees) were included in the analysis, with a mean follow-up of 6.6 years (from 2 to 13.7 years). There was an improvement in KSS (28 +/- 23 vs. 81 +/- 6, respectively; p < 0.0001) as well as functional KSS (25 +/- 12 vs. 57.5 +/- 21, respectively; p = 0.0001). There was less occurrence of annual knee giving way episodes after total knee replacement (11.9+/-16.1 vs. 5.1+/-13.7, respectively; p = 0.04). Even though the total knee replacement allowed a slight recurvatum, it was smaller than the preoperative recurvatum (13° vs. 8°, respectively; p = 0.04). Seven complications with reintervention (7/24; 29%) were found. The presence of a residual post operative recurvatum correlated with better KSS (ρ = 0.53, CI95% [0.15; 0.77]; p = 0.008). The number of postoperative annual knee giving way episodes was inversely correlated with persistent postoperative recurvatum (ρ = -0.42, CI95% [-0.69; -0.01]; p = 0.04) but was not correlated with the type of constraint (ρ = -0.26, CI95% [-0.6; 0.15]; p = 0.21) nor with quadricipital muscle strength (ρ = 0.21, CI95% [-0.21; 0.56]; p = 0.33).

Conclusion: TKA has a good mid-term functional outcome for knee osteoarthritis in patients with sequelae of poliomyelitis. Preserving a residual recurvatum postoperatively gives better clinical results without increasing the risk of ligament instability or early aseptic loosening.

Level of evidence: IV.

Keywords: Acquired joint deformities; Arthroplasty; Knee; Osteoarthritis; Poliomyelitis.

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Conflict of interest statement

Declarations. Conflict of interest: The authors, their immediate families and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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