Total knee arthroplasty in Charcot's joint.

Abstract

The authors report three cases with neuropathic (Charcot) knee joint due to tabes dorsalis in which total knee arthroplasty (TKA) was performed. Three cases (5 joints) were observed for more than 8 years after TKA. No ataxia was seen before or after surgery. The postoperative clinical course had been satisfactory in two cases (3 joints) for 9-10 years after TKA with no evidence of loosening. Although the other case had medial condylar fracture of the right upper tibia during postoperative treatment, the clinical course of the right knee had been satisfactory over the 7 years since revision arthroplasty using a tibial component with a long stem. This case also had loosening of the left tibial component 8 years after TKA. Total knee arthroplasty appears to be useful for the treatment of Charcot's joint with no ataxia at Eichenholtz' stage of coalescence and reconstruction if (1) proper surgical techniques to establish good ligamentous balancing and bony alignment by releasing ligaments are employed; (2) an adequate amount of bone is resected and remaining bony defects are reinforced with bone graft; (3) long-stem components are used on both the femoral and tibial sides.