Total Knee Arthroplasty using Computer Assisted Surgery in Paget ’s disease of Knee-A case report
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 6
Abstract
The purpose of this case report is to highlight the advantages of computer assisted navigation surgery (CAS) to improve the accuracy in performing Total Knee Arthroplasty (TKA) in a patient affected by Paget’s disease of the femur and secondary osteoarthrosis of knee. Paget’s disease can be associated with technical difficulties while performing knee arthroplasty because of intra and/or extra-articular deformity in either sagittal or coronal planes or both and there are published reports of sub-optimal varus or valgus placement of components by the manual technique. A 55-year-old male with monostotic Paget’s involvement of the femur with lateral femoral bowing and end stage arthrosis in the knee was managed with a primary cemented cruciate-retaining TKA using Aesculap Orthopilot 5.0 navigation system. His pre-op VAS score of 8/10 and Oxford Knee Score of 20 improved to 2/10 and 42 respectively at 1 year follow up. Knee involvement with Paget’s in Indian population is extremely rare and we are not aware of any previous case reports of using CAS in performing TKA in Paget’s. CAS can obviate the need for corrective osteotomy when performing TKA in patients with extra-articular deformity. Paget’s disease is a disorder of bone characterized by increased bone turnover, enlargement and thickening of the bone which is unusually brittle, more prone for deformity or fractures in weight bearing joints and arthritis of joints with affected adjacent bones [1]. As the proximal femur and pelvis are more commonly affected, hip arthritis and challenges with total hip arthroplasty [2,3] are well described than the knee arthritis and total knee arthroplasty [4]. We report a case of monostotic Paget’s involvement of distal femur and associated knee arthritis that underwent a total knee arthroplasty by computer assisted surgery. Paget’s involvement especially isolated involvement of distal femur and knee in Indian population is rare as compared to the Western population [5]. We are not aware of any previous reports of using computer assisted surgery in Paget’s involvement of the knee. The purpose of this report is to highlight the role of computer assisted surgery in achieving optimal component alignment in cases of intra or extra articular deformity which is seen with Paget’s disease. Case Details A 56-year-old male presented to us with severe disabling pain in his right knee affecting his day to day activities and which failed to respond to conservative measures. His plain radiographs showed mixed sclerotic and lytic lesions involving the entire shaft of the femur and a diagnosis of Paget’s was made on the typical radiological signs [6] on plain radiographs (Figures 1 & 2) and MRI (Figure 3). There was an anterolateral bowing of the femur about 100 and knee arthrosis changes with intra-articular varus deformity. There was no involvement of the tibia (Figure 2). His pre-operative pain score was 8 on visual analogue scale (VAS) and Oxford Knee Score [7] (OKS) was 20. The patient underwent a primary cemented cruciate retaining TKA by computer assisted navigation system (B Braun Columbus, Aesculap Orthopilot 5.0 navigation). The patient was placed supine, under spinal anaesthetic and tourniquet control a midline incision with sub vastus arthrotomy was performed. Using femur and tibia infra-red trackers, registration of the thefollowing bony landmarks was made-posterior most part of medial and lateral femoral condyles, lowest point of medial tibial plateau, highest point of lateral tibial plateau, knee centre, anterior femoral cortex, most prominent points of medial and lateral malleoli and hip, knee and ankle centres were marked.
Authors and Affiliations
Eachempati KK, Dannana CS, Boyapati G
Keywords
Related Articles
- EP ID EP578392
- DOI 10.26717/BJSTR.2017.01.000510
- Views 162
- Downloads 0
Management of Outbreak of Salmonellosis in a Pig Farm Revealed Human Source of Infection in Cameroon
Food-borne Zoonoses such as salmonellosis are major public health problem worldwide. In this study, we described the management of an outbreak of salmonellosis in a pig farm in the South region...
Device for Detecting Glaucoma
This is a diagnostic device to measure the Intraocular Pressure (IOP) of eyeball, a key indicator for glaucoma. This is a degenerative disease characterized by progressive loss of visual field. According to Glaucoma soci...
Efficacy and Safety of Elbasvir/Grazoprevir Combination Therapy for Chronic Hepatitis C
Objective: A phase III clinical study of combination therapy with elbasvir (EBR) and grazoprevir (GZR) was conducted in Japan, and the additive therapeutic effects were obtained. In this study, we report safety and effic...
Why should we perform hemodynamic ramp test following left ventricular assist device implantation?
Left ventricular assist device (LVAD) is a strong therapeutic tool to improve survival in patients with advanced heart failure, whereas not a few patients have potentially abnormal hemodynamics despite LVAD supports. Hem...
Biochemical, Anti-Diarrhoeal and Anti-Gastric Ulcer Activities of Commiphora myrrha
Myrrh is a spiny, deciduous shrub or small tree growing about 5 meters tall. It usually has a small but distinct bole. An oleo-resin gum exudes from the bark of this species and various other members of the Commiphora ge...