Aditi Mahajan, BS, MEd
Medical Student
Georgetown University School of Medicine - 3900 Reservoir Rd NWWashington D.C., DC 20007UNITED STATES - Washington D.C., DC
Washington, DC, District of Columbia, United States
Shreya Patel, DO
Resident Physician
Georgetown University School of Medicine
Washington D.C., District of Columbia, United States
.jpg "Laura J. Malmut, MD photo")
Laura J. Malmut, MD
Medical Director of Transplant Rehabilitation, Assistant Professor, Associate Clerkship Director
MedStar National Rehabilitation Hospital and Georgetown University School of Medicine
Washington, District of Columbia, United States
A 67-year-old female with history of right middle cerebral artery stroke, left hemiplegia, and right standard TKA (Total Knee Arthroplasty) presented with left-sided end-stage knee osteoarthritis. The patient had significant difficulties mobilizing secondary to severe hyperextension of her knee in the setting of spasticity, weakness, and quadriceps muscle atrophy. A brace was used to limit knee hyperextension, but the patient ultimately decided to pursue surgical intervention. Due to her neurologic impairments, a standard TKA was not recommended, and a left hinge TKA was performed. Her rehabilitation course was hampered by persistent pain and fear in engaging in functional mobility.
Discussions:
Standard TKAs are preferred when medial and lateral ligaments are stable enough for coordinated knee movement [1]. However, when these ligaments are compromised, a standard prosthesis may lack sufficient support. A hinged TKA offers an alternative by incorporating a mechanical hinge that connects the femoral and tibial components, ensuring stability even without functional ligaments [2]. This is particularly beneficial for patients with hemiplegia, where muscle weakness and spasticity can destabilize the joint. In this case, the surgeon opted for a hinged TKA to address the patient's instability and misalignment, aiming to improve functional outcomes by accommodating the abnormal forces at the joint. One downside to the hinged TKA is decreased lifespan of the prosthesis. The decision to undergo total knee arthroplasty is inherently complex, particularly in patients with a history of stroke and neurological deficits. Outcomes can be unpredictable due to joint instability caused by spasticity, contractures, and ligament instability. In patients with underlying neurological deficits, a hinged TKA can provide increased stability, correct abnormal contractures, and mitigate weakness. However, successful recovery ultimately depends on a comprehensive rehabilitation program focused on pain management, strengthening muscles, and restoring functional mobility for daily activities.
Conclusions:
