Bilateral Custom-fit Total Knee Arthroplasty in a Patient With Poliomyelitis

The authors are from the Centre Orthopédique Santy, Lyon, France.

Drs Tardy, Murphy, and Fayard have no relevant financial relationships to disclose. Dr Chambat has received royalties from Tornier Company for serving as a consultant.

The incidence of poliomyelitis has declined in many Western countries as a result of the widespread use of poliovirus vaccine. Nevertheless, although polio has been eradicated in France, there are still 40,000 to 55,000 individuals with polio sequelae, with a mean age of 55 to 60 years.1 Deformities caused by this disease are responsible for degenerative joint damage. Some studies2â[euro]"6 have reported the results of total knee arthroplasty (TKA) in patients with poliomyelitis. The authors report an original case of bilateral custom-fit hinged TKA in a patient with a history of poliomyelitis.

<bold>Case Report</bold>

A 66-year-old man consulted the authors because of bilateral chronic knee pain. He had poliomyelitis since childhood. He reported pain as 6 of 10 on a visual analog scale. The patient walked with crutches and had no history of trauma or infection.

On physical examination, the patient was lean, measuring 173 cm in height and weighing 68 kg. He had bilateral, uncorrectable valgus deformities and walked with bilateral knee recurvatum of 30°. The quadriceps were atrophic, and he had grade 1 strength bilaterally, with no effective muscle contractions. Hamstring strength was normal. Findings on ankle examination were also normal.

Radiographs showed tricompartmental grade 4 osteoarthritis of both knees, with valgus deformity of 14° on the left knee and 11° on the right knee (<bold>Figure 1</bold>).

Surgery was performed on both knees 8 months apart, with cemented custom-fit hinged total knee arthroplasty with 30° of recurvatum in the tibial keel (<bold>Figure 2</bold>). Preoperative planning was used, especially for the tibial cut, to anticipate the bone cut (<bold>Figure 3</bold>). The authors used a classic anteromedial approach, with large medial and lateral soft tissue release. Tibial tubercle osteotomy was not necessary to expose the knee. The tibial cut was performed first using a custom cutting block with an inverse tibial slope of 30° to obtain the desired recurvatum. For tibial bone preparation, the authors used a posterior point of entry to allow intramedullary guide and tibial keel passages. For the femoral cut, an intramedullary guiding rod was used.

Postoperative...