Roberts Conference July 21, 2005

History  64 year old male  6 yrs s/p Left Knee Arthrodesis following TKA  Significantly short on affected side  2 falls resulting in Hip Fractures  Successful TKA on Right

Operative Planning  Patient Requesting TKA  ESR, CRP and WBC all Normal  No Swelling or external evidence of infection

Conversion Athrodesis to TKA Kreder et. al: 18 knees  28% failure (infection, component failure) Cameron and Hu: 17 knees  53% failure (tibial component loosening, ligamentous laxity, quad rupture, wound breakdown, repeat athrodesis) Kim et. al: 30 knees  53% failure; mean flexion 75 deg, 9 deg extension deficit Henkel et. al: 7 knees  29% failure; 71% re- operation; most with increased pain on walking Warner: Three phase “Judet quadricepsplasty” to mobilize extensor mechanism.

Holden DL, Jackson DW. Considerations in total knee arthroplasty following previous knee fusion. Clin Orthop.1988; 227: Kreder HJ, Williams JI, Jaglal S, Axcell T, Stephen D. A population study in the Province of Ontario of the complications after conversion of hip or knee arthrodesis to total joint replacement. Can J Surg.1999; 42: Bradley GW, Freeman MA, Albrektsson BE. Total prosthetic replacement of ankylosed knees. J Arthroplasty. 1987;2: Cameron HU. Role of total knee replacement in failed knee fusions. Can J Surg.1987; 30: Naranja RJ Jr, Lotke PA, Pagnano MW, Hanssen AD. Total knee arthroplasty in a previously ankylosed or arthrodesed knee. Clin Orthop. 1996;331 : Henkel TR, Boldt JG, Drobny TK, Munzinger UK. Total knee arthroplasty after formal knee fusion using unconstrained and semiconstrained components: a report of 7 cases. J Arthroplasty.2001; 16: Cameron HU, Hu C. Results of total knee arthroplasty following takedown of formal knee fusion. J Arthroplasty. 1996;11: Warner JP. The Judet quadricepsplasty for management of severe posttraumatic extension contracture of the knee. A report of a bilateral case and review of the literature. Clin Orthop.1990; 256: