RESUMEN
Patients with leprosy are known to tend to develop neuropathic arthropathy, known as Charcot joint. There are no case reports of total knee arthroplasty (TKA) in patients with leprosy with polyarticular neuropathic arthropathy, and the results are unknown. In this study, we report a case of TKA in a patient with leprosy with polyarticular neuropathic arthropathy and discuss its outcomes and indications. Right TKA using the NexGen Legacy Constrained Condylar Knee implant was performed in a 62-year-old man with neuropathic arthropathy in multiple joints with clinical symptoms, particularly in the right knee. Seven years post-operation, the American Knee Society Score-knee and -function, which represent knee function and activities of daily living on a scale of 100 points, were significantly improved compared with preoperative values, from 30 to 99 points and 0 to 60 points, respectively. Indications for arthroplasty for neuropathic arthropathy should be carefully considered in each individual case. In this case, the patient had neuropathic arthropathy in multiple joints; however, TKA was performed because recovery of function in the right knee was expected to significantly improve the patient's activities of daily living, and a good mid-term clinical outcome was achieved. Therefore, indications for arthroplasty should be considered in patients with systemic neuropathic arthropathy such as leprosy, and with accurate assessment and appropriate implant selection, good long-term outcomes may be expected.
Asunto(s)
Artropatía Neurógena , Artroplastia de Reemplazo de Rodilla , Lepra , Masculino , Humanos , Persona de Mediana Edad , Artroplastia de Reemplazo de Rodilla/métodos , Artropatía Neurógena/diagnóstico , Artropatía Neurógena/etiología , Artropatía Neurógena/cirugía , Actividades Cotidianas , Articulación de la Rodilla/cirugía , Lepra/complicaciones , Lepra/diagnóstico , Lepra/cirugíaRESUMEN
We describe the results of arthrodesis for the treatment of recurrent acute neuropathic bone disease in 24 feet and of chronic disease with deformity in 91 feet, undertaken between January 1984 and December 2003. All were due to leprosy. Correction of the deformity was achieved in 80 of 106 feet (76%) and fusion in 97 of 110 feet (88%). In the 24 feet in which recurrent neuropathic bone disease was the reason for surgery, 17 (71%) obtained stability while in seven (29%) symptoms recurred postoperatively. Complications were experienced following 58 of the 110 operations (53%). In patients presenting primarily with deformity with a minimum follow-up of two years (79 feet), there was a reduced frequency of ulceration in 40 (51%). Normal footwear could be worn by 32 patients (40%) after surgery, while 40 (51%) required a moulded insole. Arthrodesis of the ankle in the neuropathic foot due to leprosy has a good overall rate of success although the rate of complications is high.
Asunto(s)
Artrodesis/métodos , Artropatía Neurógena/cirugía , Deformidades Adquiridas del Pie/cirugía , Enfermedades del Pie/cirugía , Adolescente , Adulto , Anciano , Artrodesis/efectos adversos , Artropatía Neurógena/etiología , Niño , Femenino , Enfermedades del Pie/etiología , Humanos , Lepra/complicaciones , Masculino , Persona de Mediana Edad , Reoperación , Estudios Retrospectivos , Zapatos , Resultado del TratamientoRESUMEN
Charcot joint is a disease that often occurs in patients with diabetes mellitus, tabes dorsalis, syringomyelia, chronic alcoholism, leprosy, trauma, or infection after fractures and dislocations. The treatment for Charcot joint has various complications, such as skin lesions, infections, and delayed union. We present our experience with a male patient who developed Charcot joint-like changes without diabetes mellitus or any other disease after an ankle fracture due to minor trauma.
Asunto(s)
Traumatismos del Tobillo/complicaciones , Artropatía Neurógena/etiología , Artropatía Neurógena/patología , Fracturas Óseas/complicaciones , Accidentes por Caídas , Adulto , Traumatismos del Tobillo/diagnóstico por imagen , Traumatismos del Tobillo/rehabilitación , Artropatía Neurógena/cirugía , Estudios de Seguimiento , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/rehabilitación , Humanos , Puntaje de Gravedad del Traumatismo , Imagen por Resonancia Magnética , Masculino , Procedimientos Ortopédicos/métodos , Aparatos Ortopédicos , Radiografía , Rango del Movimiento Articular/fisiología , Recuperación de la Función , Medición de Riesgo , Resultado del TratamientoRESUMEN
Charcot joint is a disease that often occurs in patients with diabetes mellitus, tabes dorsalis, syringomyelia, chronic alcoholism, leprosy, trauma, or infection after fractures and dislocations. The treatment for Charcot joint has various complications, such as skin lesions, infections, and delayed union. We present our experience with a male patient who developed Charcot joint-like changes without diabetes mellitus or any other disease after an ankle fracture due to minor trauma.
Asunto(s)
Masculino , Humanos , Adulto , Accidentes por Caídas , Rango del Movimiento Articular/fisiología , Aparatos Ortopédicos , Artropatía Neurógena/cirugía , Artropatía Neurógena/etiología , Artropatía Neurógena/patología , Fracturas Óseas , Fracturas Óseas/complicaciones , Fracturas Óseas/rehabilitación , Medición de Riesgo , Procedimientos Ortopédicos/métodos , Resultado del Tratamiento , Estudios de Seguimiento , Traumatismos del Tobillo , Traumatismos del Tobillo/complicaciones , Traumatismos del Tobillo/rehabilitación , Puntaje de Gravedad del Traumatismo , Imagen por Resonancia Magnética , Recuperación de la FunciónRESUMEN
Twenty-four patients who had arthrodesis of one or both ankles for leprotic neuroarthropathy were followed for an average of nine years and five months. At operation, after the removal of cartilage, joint debris, and sclerotic bone, the ankle joint was transfixed with a Küntscher intramedullary nail, and staples or Kirschner wires were used to control rotation. Fusion of bone was obtained in nineteen (73 per cent) of the twenty-six ankles. Failure to obtain fusion was due to postoperative infection in four patients, deficiency of the site of arthrodesis in one patient, and refracture through the site of fusion in two patients. When arthrodesis was successful, additional neuroarthropathic destruction of the mid-tarsal joint was halted, and the preoperative clinical symptoms of dull pain, local warmth, swelling, and instability were relieved.