A Systematic Review of Total Knee Arthroplasty in Neurologic Conditions: Survivorship, Complications, and Surgical Considerations

Patients with neurologic disorders present a unique set of challenges for knee surgeons because of contractures, muscle weakness, spasticity, and ligament instability. The primary purpose of this review was to report the outcomes of total knee arthroplasty (TKA) in these patients, including survivor...

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Published inThe Journal of arthroplasty Vol. 35; no. 11; pp. 3383 - 3392
Main Authors Pomeroy, Eoghan, Fenelon, Christopher, Murphy, Evelyn P., Staunton, Peter F., Rowan, Fiachra E., Cleary, May S.
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.11.2020
Subjects
Arthroplasty, Replacement, Knee - adverse effects
Humans
Knee Joint - surgery
Knee Prosthesis
multiple sclerosis
neurologic disorders
Parkinson disease
poliomyelitis
Survivorship
total knee arthroplasty
Treatment Outcome
Parkinson disease
total knee arthroplasty
survivorship
neurologic disorders
poliomyelitis
multiple sclerosis
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Abstract Patients with neurologic disorders present a unique set of challenges for knee surgeons because of contractures, muscle weakness, spasticity, and ligament instability. The primary purpose of this review was to report the outcomes of total knee arthroplasty (TKA) in these patients, including survivorship, complications, and surgical considerations. We performed a systematic review of articles using PubMed, Cochrane Central, EMBASE, and Google Scholar. All studies reporting outcomes of TKA in patients with Parkinson disease, multiple sclerosis, poliomyelitis, Charcot joint, spina bifida, stroke, and cerebral palsy were included. In total 38 studies were included: 22 studies (461 patients) reported patient-reported outcome measures and 24 studies (510 patients) reported survivorship. All 38 studies reported complication rates. TKA resulted in an improvement in functional outcome in all series. Complication rate was higher in patients with neurologic conditions. Of studies reporting survivorship, mean follow-up ranged from 1 to 12 years with survivorship from 66% to 100%. All levels of implant constraint were reported without consensus. Limited rehabilitative data exist. TKA in patients with neurologic disorders improves symptoms and function but carries significant risk. This review helps surgeons preoperatively counsel their patients in an informed manner. Careful planning, perioperative care, and appropriate implant selection may mitigate risk of complication.
AbstractList Patients with neurologic disorders present a unique set of challenges for knee surgeons because of contractures, muscle weakness, spasticity, and ligament instability. The primary purpose of this review was to report the outcomes of total knee arthroplasty (TKA) in these patients, including survivorship, complications, and surgical considerations. We performed a systematic review of articles using PubMed, Cochrane Central, EMBASE, and Google Scholar. All studies reporting outcomes of TKA in patients with Parkinson disease, multiple sclerosis, poliomyelitis, Charcot joint, spina bifida, stroke, and cerebral palsy were included. In total 38 studies were included: 22 studies (461 patients) reported patient-reported outcome measures and 24 studies (510 patients) reported survivorship. All 38 studies reported complication rates. TKA resulted in an improvement in functional outcome in all series. Complication rate was higher in patients with neurologic conditions. Of studies reporting survivorship, mean follow-up ranged from 1 to 12 years with survivorship from 66% to 100%. All levels of implant constraint were reported without consensus. Limited rehabilitative data exist. TKA in patients with neurologic disorders improves symptoms and function but carries significant risk. This review helps surgeons preoperatively counsel their patients in an informed manner. Careful planning, perioperative care, and appropriate implant selection may mitigate risk of complication.
BACKGROUNDPatients with neurologic disorders present a unique set of challenges for knee surgeons because of contractures, muscle weakness, spasticity, and ligament instability. The primary purpose of this review was to report the outcomes of total knee arthroplasty (TKA) in these patients, including survivorship, complications, and surgical considerations. METHODSWe performed a systematic review of articles using PubMed, Cochrane Central, EMBASE, and Google Scholar. All studies reporting outcomes of TKA in patients with Parkinson disease, multiple sclerosis, poliomyelitis, Charcot joint, spina bifida, stroke, and cerebral palsy were included. RESULTSIn total 38 studies were included: 22 studies (461 patients) reported patient-reported outcome measures and 24 studies (510 patients) reported survivorship. All 38 studies reported complication rates. TKA resulted in an improvement in functional outcome in all series. Complication rate was higher in patients with neurologic conditions. Of studies reporting survivorship, mean follow-up ranged from 1 to 12 years with survivorship from 66% to 100%. All levels of implant constraint were reported without consensus. Limited rehabilitative data exist. CONCLUSIONTKA in patients with neurologic disorders improves symptoms and function but carries significant risk. This review helps surgeons preoperatively counsel their patients in an informed manner. Careful planning, perioperative care, and appropriate implant selection may mitigate risk of complication.
Author Pomeroy, Eoghan
Murphy, Evelyn P.
Rowan, Fiachra E.
Cleary, May S.
Fenelon, Christopher
Staunton, Peter F.
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  organization: Department of Trauma & Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
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Issue 11
Keywords Parkinson disease
total knee arthroplasty
survivorship
neurologic disorders
poliomyelitis
multiple sclerosis
Language English
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Snippet Patients with neurologic disorders present a unique set of challenges for knee surgeons because of contractures, muscle weakness, spasticity, and ligament...
BACKGROUNDPatients with neurologic disorders present a unique set of challenges for knee surgeons because of contractures, muscle weakness, spasticity, and...
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StartPage 3383
SubjectTerms Arthroplasty, Replacement, Knee - adverse effects
Humans
Knee Joint - surgery
Knee Prosthesis
multiple sclerosis
neurologic disorders
Parkinson disease
poliomyelitis
Survivorship
total knee arthroplasty
Treatment Outcome
Title A Systematic Review of Total Knee Arthroplasty in Neurologic Conditions: Survivorship, Complications, and Surgical Considerations
URI https://dx.doi.org/10.1016/j.arth.2020.08.008
https://www.ncbi.nlm.nih.gov/pubmed/32873450
https://search.proquest.com/docview/2439634008
Volume 35
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