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Surgery Case series

Kinematic alignment technique in total knee Heterotopic ossification after total hip

arthroplasty arthroplasty

Dr. Santoshkumar Minimizes the stress on ligaments by decreasing the Dr. Raghuvansh Kumar II revision surgery [2]
anatomical change of bone
[1]
Hakkalamani Safe and accurate approach with generic Pandey The patient reported with recurrent left hip pain 1.5
years after first revision, with an elevated CRP level
instrumentation [1] (range: 0.7-2.6mg/dL).
Joint Replacement and Arthroscopy
Preserves the original knee kinetics [1] and improves HOD - Orthopedics & Joint Replacement A second revision surgery was then performed via a
BGS Global Gleneagles Hospitals, Bengaluru knee balance [2]
Venkateshwar hospital, New Delhi posterior approach.
[2]
Better soft-tissue tension and provides a more The surgeon excised the scar tissue, removed existing
Introduction normal feeling knee than those treated with MA [3] Introduction osteophytes and excessive cement around the
proximal site of the stem to allow the removal of the
Total knee arthroplasty (TKA) is the definitive surgical Clinical evidence Heterotopic ossification (HO) is any bone formation well-fixed femoral stem.
option for advanced osteoarthritis of knee. [1]
Following is the compilation of a deluge of clinical in the soft tissues that develops after surgery or Antibiotic prophylaxis [2] Outcome [2]
There is a high dissatisfaction rates of up to 20% evidence derived from studies involving KA-TKA: without a well-defined precipitating event. [1]
reported in uncomplicated TKA [1] and this leads to a Oral antibiotics were At the latest follow-up, the
search for accurate recreation of the constitutional (or Study Study design Conclusion Prevalence and etiology patient did not report any
pre-arthritic) alignment of the knee [2] prescribed (minocycline +
Hsu et al. Prospective study to All five knee phenotypes The reported rates of HO after total hip arthroplasty sulfamethoxazole- left hip pain, and the CRP
The kinematic alignment (KA) technique in TKA aims (2020) assess clinical significantly improved (THA) range widely from 2% to 90%, [1] trimethoprim) to the patient level remained within the
functional outcomes with a
outcome in 122
to restore the native alignment of the knee joint patients (139 knees) total survival rate of 99.3% for 3 months after normal range for >3years.
The patient’s hip function
anatomy based on the five most common knee at 3-year follow-up. [1] Although the cause of HO remains unclear, II revision surgery. improved, and the PJI was
phenotypes. [1] MacDessi et al. Randomized Restoring the constitutional periprosthetic joint infection (PJI) after THA is often controlled following two
(2020) superiority trial alignment with KA in TKA implicated. [2] revision surgeries.
comparing KA to results in a statistically
Surgical protocol MA in a total of 125 significant improvement in Radiation and NSAIDs are effective aids for
patients (138 knees) quantitative knee balance [2] prophylaxis of HO.
Individualized alignment targets are set for each KA group had less bone recuts Conclusion
patient according to each patient’s knee phenotype to and tibiofemoral lift-offs [2]
compared to MA group.
perform KA-TKA. (Figure 1) [1] Operative Intervention The management of HO in the presence of PJI is
Howell et al. Level III 10-year KA-TKA did not adversely difficult. [2]
(2018) follow-up study affect the implant survival, Though an effective option, surgical excision should
Type I (Neutral) No adjustment involving 217 yearly revision rate and level be considered only for patients with functional In such cases, a dual approach to the hip has to be
[3]
patients (222 knees) of function practised to enhance clearance of the HO. [2]
deficits as a result of HO. [3]
Conclusion Antibiotics should be administered intravenously
LDFA: 87 Timing of intervention is different for different
Type II (Neutral) following THA, with consideration of additional oral
MPTA: 87
Evidence supports the restoration of knee joint etiologies. For HO following THA, early excision is antibiotics for patients with a PJI. [2]
alignment with individualized target according to recommended as it allows better differentiation of
LDFA: 87-90
Original MPTA: 85-87 original knee phenotype establishing KA as a viable the ectopic bone from normal callus and scar at the References
Type III (Varus)
phenotype Medial soft tissue relase alternative to MA. operated site. [3]
Reduction osteotomy
1. Iorio, Richard MD; Healy, William L. MD Heterotopic
LDFA: 90-93 References Ossification After Hip and Knee Arthroplasty: Risk Factors,
Type IV (Varus) MPTA: 85-87 Case report of a complex HO Prevention, and Treatment, Journal of the American Academy of
Medial soft tissue relase
Reduction osteotomy 1. Hsu et al. Total knee arthroplasty according to the original knee I revision surgery [2] Orthopaedic Surgeons: November 2002 - Volume 10 - Issue 6 - p
phenotypes with kinematic alignment surgical technique—early 409-416
LDFA: 87 clinical and functional outcomes. BMC Musculoskeletal A 78-year-old male patient who underwent cemented 2. Yutaka Kinoshita, Shunji Nakano, Shinji Yoshioka, Masaru
Type V (Valgus) MPTA: 90 Disorders (2020) 21:839 Nakamura, Tomohiro Goto, Daisuke Hamada, Koichi Sairyo, "A
Lateral soft tissue relase THA, 17 years earlier reported with severe HO. Rare Case of Extremely Severe Heterotopic Ossification after
2. MacDessi SJ, Griffiths-Jones W, Chen DB, et al. Restoring the
Figure 1- Target angles of LDFA and MPTA according to original phenotype of knee constitutional alignment with a restrictive kinematic protocol Revision THA was performed using a direct lateral Primary Total Hip Arthroplasty due to Persistent Mild
Abbreviations: LDFA-lateral distal femur angle; MPTA- medial proximal tibial angle approach. Periprosthetic Joint Infection", Case Reports in Orthopedics, vol.
improves quantitative soft-tissue balance in total knee 2021, Article ID 8849929, 7 pages, 2021.
KA-TKA Advantages arthroplasty: a randomized controlled trial. Bone Joint J. The surgeon excised the HO, removed the loosened 3. Ranganathan K, Loder S, Agarwal S, et al. Heterotopic
2020;102-B(1):117-124.
acetabular cup and fibrous tissue, and placed an Ossification: Basic-Science Principles and Clinical Correlates
Restores the pre-arthritic knee joint by resecting bones 3. Howell SM, Shelton TJ, Hull ML. Implant Survival and Function allograft. [published correction appears in J Bone Joint Surg Am. 2015 Sep
parallel to the joint line of the femur and tibia [1] Ten Years After Kinematically Aligned Total Knee Arthroplasty. J 2;97(17):e59.
Arthroplasty. 2018;33(12):3678-3684. Femoral stem was not replaced due to hip ankyloses.