Sequential Knee and Hip Arthroplasty in a Patient With Pfeifer-Weber-Christian Disease

Abstract

Pfeifer-Weber-Christian Disease (PWCD) is a rare chronic inflammatory condition characterized by recurrent painful subcutaneous nodules and systemic manifestations. Long-term corticosteroid therapy, essential for managing PWCD, predisposes patients to complications such as osteoarthritis and avascular necrosis, often necessitating joint replacement surgeries. This report discusses a 38-year-old woman with a 15-year history of PWCD who underwent sequential knee and hip arthroplasty due to severe joint degeneration. The patient presented with debilitating pain, significant functional impairment, and advanced degenerative changes in the left knee and right hip. A multidisciplinary team provided comprehensive perioperative care to address the complexities of chronic inflammation, immunosuppression, and poor bone quality. This case highlights the feasibility of joint replacement in PWCD patients when a multidisciplinary approach and meticulous planning are applied. It underscores the importance of individualized surgical strategies and extended follow-up to optimize outcomes in complex cases.

Keywords: Chronic inflammation; Hip arthroplasty; Knee arthroplasty; Panniculitis; Pfeifer-Weber-Christian Disease; Surgical complications.

Figure 1

Clinical photograph of the patient. This image illustrates the physical presentation of the patient, highlighting the characteristic findings associated with Pfeifer-Weber-Christian Disease, including trophic skin changes, hyperpigmentation, and the 30° valgus deformity in the left knee. These clinical features underscore the systemic and localized challenges in managing advanced joint disease in patients with chronic inflammatory conditions.

Figure 2

Anteroposterior (AP) radiograph of both knees and lateral radiograph of the left knee. The images reveal advanced Grade IV osteoarthritis in the left knee, characterized by significant valgus deformity, joint space obliteration, multiple osteophytes, and severe patellofemoral degeneration. These radiographic findings confirm the extensive structural damage and serve as critical preoperative references for planning the arthroplasty procedure.

Figure 3

Panoramic radiographs of the lower limbs. The panoramic imaging highlights the overall alignment and structural condition of the lower limbs, revealing a 3 cm discrepancy in limb length, severe valgus deformity of the left knee, and evidence of advanced joint degeneration in the right hip. These findings are crucial for surgical planning and postoperative alignment correction.

Figure 4

Anteroposterior (AP) and axial radiographs of the right hip. These radiographs demonstrate advanced Grade IV osteoarthritis of the right hip, with complete joint space obliteration, femoral head collapse, neoacetabulum formation, and extensive osteophyte development. The images also highlight the poor bone quality, which necessitated the use of a cemented femoral prosthesis and dual-mobility head during arthroplasty.

Figure 5

3D reconstruction and 3D planning for hip arthroplasty. The 3D reconstruction and preoperative planning images illustrate the detailed anatomical evaluation of the right hip, including the extensive bone deformities and femoral head collapse. These tools facilitated precise surgical planning, enabling the selection of a cemented femoral prosthesis and dual-mobility head to address the patient’s poor bone quality and ensure optimal implant stability. 3D, 3-dimensional.

Figure 6

Postoperative outcome of knee arthroplasty. This image shows the immediate postoperative results following left knee arthroplasty with a hinged prosthesis. The correction of the severe valgus deformity is evident, and the alignment and stability of the joint are restored. The use of low-reactivity sutures minimized inflammation and promoted optimal wound healing in this patient with underlying chronic panniculitis.

Figure 7

Postoperative outcome of hip arthroplasty. This image depicts the immediate postoperative results following right hip arthroplasty. The cemented femoral prosthesis and dual-mobility head successfully addressed the advanced osteoarthritis and poor bone quality. The surgical intervention restored hip alignment and improved joint stability, minimizing the risk of dislocation. Careful wound closure techniques and extended antibiotic prophylaxis were applied to reduce the risk of complications associated with the patient’s chronic inflammatory condition.