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Poliomyelitis with genu recurvatum
79%
658/832
Intraoperative lateral collateral ligament disruption
10%
81/832
Intraoperative repairable, mid-substance medial collateral ligament disruption
3%
27/832
A patient with diabetic neuropathy with sensation loss to the level of the midfoot
2%
19/832
A patient with startup pain with radiographs showing lucencies around a primary total knee arthroplasty tibial baseplate
5%
40/832
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Post-polio syndrome knee arthropathy requires a rotating hinge prosthesis (Answer choice 1). Post-polio syndrome knee arthropathy is associated with extensive ligamentous laxity and muscular atrophy/weakness surrounding the joint. This leads to substantial coronal and sagittal plane deformities preoperatively. Additionally, this prevents successful balancing and realignment post-operatively using conventional implants. Reconstruction should consist of a rotating hinge prosthesis to compensate for the knee's global instability.Prasad et al. performed a systematic review of outcomes in total knee arthroplasty (TKA) in patients with poliomyelitis. The authors included studies encompassing 82 patients and reported significant improvement in pain and knee function following surgery, with only 7% of cases requiring revision (most commonly for aseptic loosening and infection). The authors concluded quadriceps muscle power is prognostic for functional outcomes following arthroplasty and recommend the use of constrained implants.Rahman et al. retrospectively studied 14 knees with poliomyelitis treated with customized rotating hinge knee prosthesis. The authors reported all knees had satisfactory alignment with no signs of loosening at 72 months of follow-up. They concluded the customized rotating hinge knee system is effective at relieving pain and improving function in patients with poliomyelitis.Gan et al. retrospectively studied 14 patients with poliomyelitis treated with total knee arthroplasty. They reported significant improvement in AKSS, Oxford knee score, and Short Form 36 Health Survey for all patients. They concluded primary total knee arthroplasty resulted in good outcomes and improved quality of life on poliomyelitis-affected knees.Figures A and B are plain radiographs demonstrating a rotating hinge prosthesis.Incorrect answers:Answer 2 and 3: Intraoperative collateral ligament disruption can be treated with ligamentous repair, knee bracing, and possibly increasing the level of implant constraint, but does not typically require the maximum level of constraint provided by a hinged prosthesis.Answer 4: Diabetes is a very common comorbid condition in those undergoing TKA, and does not typically require an elevated level of implant constraint.Answer 5: This answer describes aseptic loosening, which is an indication for revision TKA, but does not typically require a hinged prosthesis.
2.0
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