Progressive Late-Onset Genu Recurvatum Post-Total Knee Arthroplasty: Insights from a Spinal Stenosis-Related Case Series

Document Type : RESEARCH PAPER

Authors

Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

10.22038/abjs.2024.76318.3525

Abstract

Objectives: Knee osteoarthritis is common among older individuals, necessitating Total Knee 
Arthroplasty (TKA) for end-stage cases. The aging population has increased TKA demand, leading to 
a rise in revision surgeries. Genu recurvatum, a rare complication, often req uires surgical intervention, 
with late-onset cases linked to neuromuscular conditions. This case series focuses on the infrequent 
occurrence of late-onset genu recurvatum resulting from spinal stenosis in patients without other 
predisposing conditions.
Methods: A retrospective case series of 10 patients (11 knees) referred between February 2016 and 
August 2020 due to late recurvatum instability. Exclusion criteria encompassed neuromuscular 
diseases other than spinal stenosis, prosthetic joint infection, and pre-existing recurvatum deformity. 
Data, including demographics, medical history, imaging findings, and surgical details, were collected 
retrospectively. Patient performance was assessed using the Knee Society Score (KSS) at specified 
postoperative intervals.
Results The study cohort, exhibiting hyperextension ranging from 11 to 30 degrees, underwent 
successful revision surgery using rotating hinge knee (RHK) implants after failed conservative 
measures. Follow-up assessments at 6, 18, and 24 months showed no recurrence of genu recurvatum.
Conclusion: Late-onset genu recurvatum poses a challenge, necessitating surgical intervention. 
Identifying predisposing factors is crucial, with spinal stenosis emerging as a rare cause. The use of 
posterior stabilized (PS) implants in primary surgery aligns with higher revision rates, possibly linked 
to PCL removal. Limited literature explores the spinal-genu recurvatum relationship. A stepwise 
screening protocol is proposed for high-risk patients, emphasizing history, physical examination, and 
imaging. Strategic considerations include lower constraining, a tighter extension gap, and potential use 
of Hinge implants.
 Level of evidence: V

Keywords

Main Subjects


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