Arthrodesis (AD) of the knee reduces pain and provides stability, but has severe functional and social limitations. There has been ample discussion on the value of a conversion of an AD to a total knee arthroplasty (TKA). The aim of this study was to perform a review and meta-analysis of the current literature on conversion of an AD to TKA and assess clinical outcome, complication rate, surgical technique and overall patient-related outcome measures.
PubMed, Embase, Web of Science, Cochrane, CENTRAL, CINAHL, Academic Search Premier, ScienceDirect and searching by hand for papers on conversion of AD of the knee to TKA. Two reviewers independently reviewed all titles and abstracts, and extracted the available data. Study eligibility criteria were: conversion of knee AD to TKA, five cases or more and non-oncology patients. Data consisted of study characteristics, patient demographics, clinical outcome and complications. Additionally, details on surgical technique were reviewed.
Of the 866 unique references identified, six papers were included for further analyses, comprising a total of 123 knees with conversion of AD of the knee to TKA. Mean gain of knee flexion was 80 degrees and the mean HSS score improved with 20 points. A complicated postoperative course was found in 65 % of all cases. The most frequent complication was skin necrosis (25 %), followed by arthrofibrosis (13 %), infection (11 %) and revision (11 %). Major complications such as refusion, amputation and death occurred in less than 5 % of all cases.
The majority of the papers consisted of small case series of moderate methodological quality, resulting in 123 included knees. Further series are necessary to draw definitive conclusions.
This is the first systematic review and meta-analysis on conversion of a knee arthrodesis to TKA. Good clinical results can be expected after conversion, albeit at a high risk of postoperative complications.
Conway JD, Mont MA, Bezwada HP (2004) Arthrodesis of the knee. J Bone Joint Surg Am 86-a(4):835–848 PubMed
Kim YH, Oh SH, Kim JS (2003) Conversion of a fused knee with use of a posterior stabilized total knee prosthesis. J Bone Joint Surg Am 85-a(6):1047–1050 PubMed
Cameron HU, Hu C (1996) Results of total knee arthroplasty following takedown of formal knee fusion. J Arthroplast 11(6):732–737 CrossRef
Clemens D, Lereim P, Holm I, Reikeras O (2005) Conversion of knee fusion to total arthroplasty: complications in 8 patients. Acta Orthop 76(3):370–374 PubMed
Cermak K, Baillon B, Tsepelidis D, Vancabeke M (2013) Total knee arthroplasty after former knee fusion in a patient with Ehlers Danlos syndrome. Acta Orthop Belg 79(3):347–350 PubMed
Mahomed N, McKee N, Solomon P, Lahoda L, Gross AE (1994) Soft-tissue expansion before total knee arthroplasty in arthrodesed joints. A report of two cases. J Bone Joint Surg (Br) 76(1):88–90
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ (Clin Res Ed) 339:b2700. doi: 10.1136/bmj.b2700CrossRef
Pijls BG, Dekkers OM, Middeldorp S, Valstar ER, van der Heide HJ, Van der Linden-Van der Zwaag HM, Nelissen RG (2011) AQUILA: assessment of quality in lower limb arthroplasty. An expert Delphi consensus for total knee and total hip arthroplasty. BMC Musculoskelet Disord 12:173. doi: 10.1186/1471-2474-12-173CrossRefPubMedPubMedCentral
Cowan JB, Mlynarek RA, Nelissen RG, Pijls BG, Gagnier JJ (2015) Evaluation of Quality of Lower Limb Arthroplasty Observational Studies Using the AQUILA Checklist. J Arthroplast. doi: 10.1016/j.arth.2015.03.020
Viechtbauer W (2010) Conducting meta-analyses in R with the metafor package. J Stat Softw 36(33):31–48
- Conversion from knee arthrodesis to arthroplasty: systematic review
Willem Alexander Kernkamp
Wiebe Christiaan Verra
Bart Godefridus Pijls
Jan Wilhelmus Schoones
Henrica Maria Jannetta van der Linden
Rob Gerardus Henricus Hubertus Nelissen
- Springer Berlin Heidelberg
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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