Abstract
Background
Hemophilic arthropathy is a cause of severe knee deformity, because chronic synovitis
due to repeated hemarthrosis affects the area of the epiphyseal plates in juvenile
cases. Total knee arthroplasty (TKA) is the standard treatment for end-stage knee
arthropathy. However, it is difficult to perform one-stage TKA in patients with severe
intra- and extra-articular deformities.
Case presentation
We reported a case of hemophilic arthropathy in a 55-year-old male with leg length
discrepancy of 4 cm, limited range of knee motion (−40° extension and 85° flexion),
intra-articular deformity (medial proximal tibial angle: 69°; mechanical lateral distal
femoral angle: 79°), extra-articular deformity at the distal femoral metaphyseal (30°
valgus and 45° flexion deformity), and varus malalignment (% mechanical axis: 33%).
We planned a three-stage TKA. Firstly, we performed gradual correction and lengthening
of the distal femur using Taylor spatial flame. Six months after surgery, we performed
conversion surgery from external fixation to internal fixation. Finally, we performed
TKA with rotating hinged type implant. Two years after surgery, physical examination
showed a normal gait, leg length discrepancy of 2 cm (the right leg was shorter),
improvement in the range of knee motion (0° extension and 100° flexion).
Conclusion
To the best of our knowledge, this presents the first combination of three-stage TKA
with correction of femoral deformity and leg lengthening using a Taylor spatial frame
and conversion to internal fixation in a patient with hemophilic knee arthropathy
and severe intra- and extra-articular deformities.
Keywords
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Article info
Publication history
Published online: November 18, 2022
Accepted:
October 26,
2022
Received in revised form:
April 11,
2022
Received:
April 10,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
