Primary total knee arthroplasty in patients with post-polio syndrome.

Aims: Knowledge on total knee arthroplasties (TKAs) in patients with a history of poliomyelitis is limited. This study compared implant survivorship and clinical outcomes among affected and unaffected limbs in patients with sequelae of poliomyelitis undergoing TKAs. Methods: A retrospective review of our total joint registry identified 94 patients with post-polio syndrome undergoing 116 primary TKAs between January 2000 and December 2019. The mean age was 70 years (33 to 86) with 56% males (n = 65) and a mean BMI of 31 kg/m2 (18 to 49). Rotating hinge TKAs were used in 14 of 63 affected limbs (22%), but not in any of the 53 unaffected limbs. Kaplan-Meier survivorship analyses were completed. The mean follow-up was eight years (2 to 19). Results: The ten-year survivorship free from revision was 91% (95% confidence interval (CI) 81 to 100) in affected and 84% (95% CI 68 to 100) in unaffected limbs. There were six revisions in affected limbs: three for periprosthetic femoral fractures and one each for periprosthetic joint infection (PJI), patellar clunk syndrome, and instability. Unaffected limbs were revised in four cases: two for instability and one each for PJI and tibial component loosening. The ten-year survivorship free from any reoperation was 86% (95% CI 75 to 97) and 80% (95% CI 64 to 99) in affected and unaffected limbs, respectively. There were three additional reoperations among affected and two in unaffected limbs. There were 12 nonoperative complications, including four periprosthetic fractures. Arthrofibrosis occurred in five affected (8%) and two unaffected limbs (4%). Postoperative range of motion decreased with 31% achieving less than 90° knee flexion by five years. Conclusion: TKAs in post-polio patients are complex cases associated with instability, and one in four require constraint on the affected side. Periprosthetic fracture was the main mode of failure. Arthrofibrosis rates were high and twice as frequent in affected limbs.

Outcomes of total hip replacement in limbs affected by poliomyelitis.

INTRODUCTION: The outcomes of total hip replacement in patients suffering from residual poliomyelitis are poorly covered in the literature. In this retrospective study we posed the question of whether total hip replacement performed for degenerative hip diseases in limbs with residual poliomyelitis could determine satisfactory mid-term clinical and radiographic results, with a reasonable complication rate. METHODS: A retrospective study was carried out to assess the results of 14 total hip replacements performed on 14 patients with residual poliomyelitis on the involved limb from June 1999 to September 2011. Average age at the time of surgery was 51 years (range 26-66 years). Mean duration of follow-up was 92 months (range 52-156 months). Surgery was performed through a direct lateral approach on all hips. All but one were cementless implants. RESULTS: 2 implants failed, 1 due to traumatic acetabular fracture 6 days after surgery, and 1 due to aseptic cup loosening 13 years after surgery. Surgery was uneventful in all patients except 1 (7%), who experienced a transient sensory sciatic nerve palsy. At the latest follow up Harris Hip Score was 83.3 (range 72-91) with a marked improvement when compared to preoperative score (average 52, range 32-78). No dislocations had occurred. CONCLUSIONS: Total hip replacement can be considered a feasible option for hip osteoarthritis in patients with limbs affected by residual poliomyelitis. Longer follow-up studies are needed to assess the effectiveness of unconstrained total hip replacement in polio patients.

[Treatment of "bayonet" deformity of knee from poliomyelitis].

The "bayonet" deformity from poliomyelitis is a peculiar type of deformity of knee. From January 1986 through December 1994, 23 cases of this type of knee deformity were corrected by surgery. The operative procedures performed were suprachondylar osteotomy of femur or subplateau osteotomy of tibia. The patients were followed up from 1 to 5 years, with an average of 3 years. The result rated excellent to good was 95.6%. The features of this disorder and the main points in the surgical procedure were discussed.

Is bariatric surgery effective in the treatment of the neurological motor deficit syndromes?

BACKGROUND: Persons who suffer from neurological motor deficit syndromes, such as multiple sclerosis, postpolio syndrome, cerebral palsy, myotonia or stroke, are at a particular disadvantage if they are also morbidly obese. There appears to be little in the medical literature describing the role of bariatric surgery and the management of these conditions. METHODS: We offer our experience with six such patients. All had variations of the gastric bypass procedure. RESULTS: Weight loss was quite good, in comparison to other morbidly obese patients. All six noted improved function, usually dramatically improved. CONCLUSIONS: Long-term weight maintenance and functional improvement cannot be assessed in this group of patients. One should expect difficulty in making a long-term assessment in the presence of a progressing debilitating disease. Short-term results were good, and we believe that bariatric surgery should be offered to these patients on an individual basis.

Hamstring tendon transfer for quadriceps femoris paralysis.

Fifteen cases of paralysis of the quadriceps muscles secondary to poliomyelitis were managed by hamstring tendon transfers with an average follow-up of 48 months. Results of 13.5% excellent, 73% good, and 13.5% fair were obtained, according to an objective scoring system. Significant improvement in gait pattern, relief from brace use, or "hand-on-thigh" ambulation was seen in all cases. A mean extension lag of 30 degrees was observed in patients examined in the sitting position. Lack of active terminal knee flexion, prohibiting comfortable floor sitting, was the main untoward effect and the source of complaint in four patients.

Talonavicular joint arthrodesis for paralytic post poliomyelitis forefoot instability.

A 17-year-old patient presented with paralytic valgus left foot deformity after poliomyelitis. Forefoot instability resulted from the transfer of peroneus brevis to the second metatarsal bone. This was secondary to a medial gapping of the talonavicular joint as a result of unbalanced pull of the transferred tendon. Talonavicular arthrodesis following a medial-based wedge articular resection has corrected the deformity.

Review of Elmslie's triple arthrodesis for post-polio pes calcaneovalgus deformity.

Twelve patients with residual talipes calcaneovalgus deformity due to poliomyelitis were reviewed. A two-stage Elmslie's arthrodesis was performed on nine patients with rigid deformity. Tendon transfer (peroneus brevis in one, peroneus brevis and longus in two) to the tendo Achillis insertion is used to correct the calcaneus deformity, after reduction of the calcaneus in the subtalar joint, using a Steinmann pin passed through the calcaneus. Good results were obtained in patients treated by arthrodesis. However, the deformity recurred in patients treated only with tendon transfer.

Transfer of upper pectoralis major flap for functional reconstruction of deltoid muscle.

Since January 1984, functional reconstruction of the deltoid muscle using transfer of the upper part of the pectoralis major muscle has been performed in 7 patients with deltoid dysfunction. 5-20 months follow-up (average 11) revealed marked improvement in 6 patients. During the operation, the superior and inferior parts of the pectoralis major muscle were bluntly dissected and sectioned. The upper part of this muscle was turned over and transferred to the site normally occupied by the deltoid muscle. The transposed muscle contributed to both abduction and flexion of the shoulder. The efficacy of abduction was reinforced by the increased arm of action.