You are on page 1of 22

T.K.A.

IN
POLIOMYELITIS
Prof.M.A.SEBAII
WAEL SAMIR
HISTORY OF PRESENT ILLNESS
- Female
- 57 years old
- Professor of radiology
- Known case of poliomyelitis affecting
both L.L.
- Left knee pain of long duration,
progressive course
- Progressive limitation of activity and
walking, frequent pain at rest
- Aids: 2 crutches
Examination of left knee

-Marked tenderness over the joint line


-Mild varus deformity
-Mild flexion deformity
-No medio-lateral instability
-Range of motion: 10-100
-Quadriceps strength: 2 (no straight leg
raising)
-Hamstring strength: 4-5
-Left ankle examination: normal
Examination of the right side
-Flail knee in brace
-Left ankle: arthrodesis
X-rays

- Advanced O.A. knee


A-P:
Tricom. O.A. more medially
Mild varus deformity:10
Peri-articular osteoporosis
Lateral view

Patella:
Infera, Hypoplastic
Small art.surfsce.
Long peaked non art.

Tibia :
Hypoplastic m.canal

Very short P.T


So

-Advanced O.A. left knee in polio


patient
-(HSS 47)
-Weak quadriceps strength, normal
hamstring
-Mild flexion deformity
-Contra-lateral flail knee in brace
Solutions
! Bracing : unpractical bilateral
no relief of pain
! Arthrodesis: absolute refusal by
the patient
! Arthroplasty : challenging
TKA + weak Quad.=failure
Review of literature
-Best results for patients with normal
hamstring and quadriceps power at
least antigravity.
-Patient with weak quadriceps rely on
locking of the knee in
hyperextension to walk
-TKA can reduce walking function by
limiting this ability.
Recurvatum in polio
Two types of recurvatum in polio:
(a)Bony
-Hamstring normal + weak
quadriceps
-Compensatory recurvatum
deformity: desirable-stabilize knee
in deformity
(b) Soft tissue type
-Hamstring weak+normal quadriceps
-Bad prognosis -Difficult to treat
-Recurrence is high
This compensatory recurvatum should be
built-up in the distal femur to obtain the
locking mechanism which relies on intact
supporting posterior structures

How?
- Insertion of the fem. Prosthesis in
hyperextesion (recurvatum)
- Special distal fem. Cutting jig designed with
anterior fem. Slop (Rota glide prosthesis)
-Drawback of fem. Comp.
hyperextesion position
Notching of the anterior
cortex
-Solution
upsize the fem.Component
-avoid notching
-stuff the joint ant.
Quad.lever arm.
Insertion of definite prosthesis.

No femoral notching
Post operative x-ray
Post operative x-ray
POST OPERATIVE
HYPEREXTENSION
POST OPERATIVE IN FLEXION
POSITION OF PATELLAR BUTTON
POST OPERATIVE
OVERALL ALIGNMENT
THANK YOU
PROF.M.A.SEBAEI
WAEL SAMIR

You might also like