Emrah KOVALAK, Ata CAN, Nese STEGEMANN, Ayse ERDOGAN, Fahri ERDOGAN

Diz ekleminde gelişen ankiloz sonrası total diz artroplastisi uygulaması

Özet:Amaç:Ankiloze olan diz eklemi uygun şekilde oturma, merdiven ve toplu taşımanın kullanımı dahil olmak üzere belirgin kısıtlılıklara yol açar. Bu çalışma ile amacımız, ankiloz gelişmiş olan ve total diz artroplastisi uygulanmış olgularımızın sonuçları bildirmek ve tartışmaktır.Hastalar ve metot:Bu çalışmada 2003 ile 2012 yılları arasında diz ekleminde ankiloz nedeni ile total diz artroplastisi uygulanmış olan 6 hasta geriye dönük olarak değerlendirildi. Ankiloze dizlerin etiyolojilerine baktığımızda, 2 hastada çocukluk döneminde geçirilmiş piyojenik artrit, 2 hastada eklem içi kırık, bir hastada ateşli silah yaralanması ve 1 hastada ise romatoid artrit bulunmakta idi. Klinik değerlendirme, ameliyat öncesi ve ameliyat sonrası son takipte ‘’The Hospital for Special Surgery’’ (HSS) diz derecelendirme sistemi, ‘’Western Ontario Mac Master Anketi’’ (WOMAC) ve görsel analog skala (VAS) kullanılarak yapıldı.Bulgular:Ortalama takip süresi 86 ay idi (22-126). Son kontrolde ortalama hareket açıklığı 85° (75°-95°)idi. İki hastada 10°ekstansiyonda kısıtlılık var idi. Ameliyat sonrasında ortalama HSS skorlarının 19.5 (18-22) tan 57.49’a (46-80), WOMAC skorlarının 39.75’ten (36.4-43) 62.41’e (50.8-74.5) yükseldiği görüldü. VAS skorları ise 9.5’ten (7-9) 2.8’e (2-4) geriledi. 2 hastada enfeksiyon gelişti. Bir hastada debridman ile tedavi sağlanırken, diğer hastada 2 yıl sonra artrodez yapıldı.Çıkarımlar:Tüm risk ve komplikasyonlarına rağmen yürüme ve normal bir şekilde oturabilmek hastalar için çok önemlidir. İyi bir cerrahi öncesi planlama ve dikkatli bir cerrahi ile iyi sonuçlar alınması mümkündür.Anahtar kelimeler:Diz replasman artroplastisi, diz ankilozu, diz artrodezi

Anahtar Kelimeler:

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Total knee arthroplasty after osseous ankylosis of the knee joint

Objective: A knee fusion is associated with considerable restrictions, including the inability to sit properly, use public transportation, and climb stairs. The purpose of this study is to report and discuss our cases of spontaneous ankylosed knees which were taken down and underwent total knee arthroplasty (TKA).Methods: Six patients who experienced spontaneous ankylosis of the knee undergoing conversion to TKA between 2003–2012 were enrolled retrospectively in this study. The etiology was childhood pyogenic arthritis in 2 patients, intraarticular fractures in 2, gunshot in 1, and juvenile rheumatoid arthritis in 1. The clinical data were recorded with the use of the Hospital for Special Surgery (HSS) knee rating system, Western Ontario and McMaster Questionnaire (WOMAC), and Visual Analog Scale (VAS), preoperatively and postoperatively at final follow-up.Results: The average follow-up time was 86 months (range: 22–126 months). At the final follow-up, the average range of active flexion was 85° (range: 75–95°). Postoperative average HSS knee rating system was improved from 19.5 (range: 18–22) to 57.49 (range: 46–80), WOMAC was improved from 39.75 (range: 36.4–43) to 62.41 (range: 50.8–74.5). VAS was improved from 9.5 (range: 7–9) to 2.8 (range: 2–4). A pyogenic infection developed in 2 patients; 1 was managed by debridement, and 1 was managed by arthrodesis 2 years later.Conclusion: The ability to walk and sit in a normal fashion is of great importance for patients. With good preoperative planning and careful handling, gratifying results are possible with TKA.

Keywords:

Knee ankylosis; knee arthrodesis; knee fusion; total knee arthroplasty.,

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