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The Journal of Bone and Joint Surgery (American) 84:1157-1161 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Total Knee Arthroplasty in Limbs Affected by Poliomyelitis

Nicholas J. Giori, MD, PhD and David G. Lewallen, MD

Investigation performed at the Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

Nicholas J. Giori, MD, PhD
Department of Orthopedic Surgery, Surgical Service (112), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304

David G. Lewallen, MD
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Little information is available regarding the results and complications of total knee arthroplasty in limbs affected by poliomyelitis with severe knee degeneration.

Methods: We performed a retrospective chart and radiograph review of patients with a history of poliomyelitis involving a limb that subsequently underwent primary total knee arthroplasty between 1970 and 2000. Sixteen total knee arthroplasties were performed in limbs affected by poliomyelitis in fifteen patients. Eleven patients were followed for a minimum of two years, one (two knees) died before the minimum two-year follow-up could be completed, and three were followed for less than two years. No patient was lost to follow-up.

Results: There were two periprosthetic fractures, one peroneal nerve palsy, one avulsion of the patellar tendon, and four cases of recurrent instability. These complications were related to the poor bone quality, valgus deformity, patella baja, poor musculature, and attenuated soft tissues commonly found in knees affected by poliomyelitis. Knee Society pain and knee scores were improved postoperatively for all nine knees with a two-year follow-up that had had at least antigravity quadriceps strength prior to surgery. However, Knee Society function scores remained at 0 or worsened for six of the eleven knees followed for at least two years, including those with less than antigravity strength, and four of the nine knees with at least antigravity strength. None of the prostheses loosened.

Conclusions: Pain and knee scores improved following total knee arthroplasty in patients with a history of poliomyelitis and antigravity quadriceps strength, but there was less pain relief in patients with less than antigravity quadriceps strength. Recurrence of instability and progressive functional deterioration is possible in all knees affected by poliomyelitis that have undergone total knee replacement, but they appear to occur more commonly in more severely affected knees.


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