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Page 35
Volume 13
Journal of Orthopaedics Trauma Surgery & Related Research
Arthroplasty 2018
September 24-25, 2018
Arthroplasty
September 24-25, 2018 London, UK
11
th
International Conference on
Deformity correction of foot and ankle after TKR: Case report
Gab-Lae Kim
Kangdong Sacred Heart Hospital-Hallym University, Republic of Korea
Introduction
: Total Knee Arthroplasty (TKA) has proved to be a highly successful procedure for the relief of debilitating pain
associated with degenerative joint disease. The 10 to 15-year survivorship of primary TKA now routinely exceeds 90%. However,
despite advancements in surgical technique, implant design and postoperative management, complications continue to be a relatively
common. Like infection, tendon rupture, instability which is common complication after TKR, the instability of hind foot alignment
has also been reported. We reported about a satisfied case; ankle, foot deformity correction for malrotation after TKA which didn’t
performed about correction of knee.
Case Report
: 68-year patient has visited and showed hind foot malalignment and claw toe deformity after total knee arthroplasty
one year ago. Patient was suffered by pain and feel like paralysis below ankle which was unable to walk about one year ago. Patient
has insufficient action on plantar flexion of ankle and has limited ROM of toes. Also, we found in standing position patient showed
equinovarus deformity of ankle, claw toe deformity of foot and Achilles tightening about 6 cm. On AP standing view patient showed
genu recurvatum and slightly elevation of right ankle joint. To correct these deformities, we did tibialis anterior tendon transfer, flexor
hallucis longus graft, plantar fasciotomy and ilizarov external fixator applied. AP standing view after deformity correction showed
genu recurvatum angle and hind foot alignment was improved and patient feel much better than before surgery.
Discussion
: Genu recurvatumdeformations are unordinary before adding up to knee arthroplasty, happening in under 1% of patients.
In view of its irregularity, concern may exist with respect to the repeat of the deformation and the potential for flimsiness after TKA.
Recurvatum might be related with an extreme rigid distortion, including genu valgum, capsular or ligamentous laxity and once in a
while, neuromuscular illness. Within the sight of the last mentioned, a plantar flexion contracture of the lower leg additionally might
be available. Subsequently, particular consideration ought to be offered preoperatively to assessment of the quadriceps, hamstrings
and gastrocnemius complex. Since genu recurvatum is known to repeat in patients with certain neuromuscular issue, the etiology
of the hyperextension disfigurement must be explained altogether before medical procedure. Without neuromuscular malady, be
that as it may, hyperextension disfigurements tend not to repeat after TKA. Over the past few years, many different procedures for
the correction of genu recurvatum have been proposed. The least technically challenging approach is to tighten the extension gap
by underresecting the distal femur, using a thicker polyethylene liner and placing the femoral component in slight flexion. Another
option is to tighten the collateral ligaments in extension to obtain a tighter extension gap and prevent hyperextension deformity. The
other option is to use a rotating-hinge TKA with an extension stop to reduce the risk of hyperextension instability postoperatively.
We focused on the problem of ankle joint due to genu recurvatum and performed an anterior tibialis tendon transfer and plantar
fasciotomy as the main operation for soft tissue surgery to correct the malalignment of hind foot and correct the following claw tow
deformity. We experienced a satisfactory case in which genu recurvatum was also corrected as a result of the corrected ankle joint.
Biography
Gab-Lae Kim is currently an Associate Professor in the Hallym University College of Medicine in the Department of Orthopedic Surgery at Seoul, South Korea.
kiga9@hanmail.netGab-Lae Kim, J Arthroplasty 2018, Volume 13