Total Knee Arthroplasty in Severe Unstable Knee: Case-Report and Literature Review

Document Type : CASE REPORT


1 Shariati Hospital, Tehran University of Medical Siences, Tehran, Iran

2 Imam khomeni , Tehran University of Medical Siences, Tehran, Iran


Multiplanar or global laxity in arthritic knee is rare , most of this patients have neuromuscular disorder (post poliomyelitis , spinal dystrophy) or history of knee trauma. Ligament insufficiency and severe bone loss is significant in this patient. The estimated prevalence for the concurrence of charcot marie-tooth (CMT) with myasthenia gravis (MG) suggests an extremely rare event. We have presented a 54-year-old female patient with CMT and MG complaining of progressive pain, swelling, and crepitation of the knee joints who had been undergone total knee arthroplasty (TKA) with rotating hinge prosthesis. She had an acute myasthenia crisis soon after operation with prolonged intubation and intensive care unit admission. Radiographies and physical examination revealed bilateral severe unstable arthritic knee joints and left knee posterior dislocation. Short-term postoperative follow-up revealed improved knee function and resolution of all symptoms in the operated side.


1. Mullaji AB, Shetty GM, Lingaraju AP, Bhayde S. Which
factors increase risk of malalignment of the hipknee-
ankle axis in TKA? Clin Orthop Relat Res. 2013;
2. Vail TP, Lang JE, Van Sikes C. Surgical techniques and
instrumentation in total knee arthroplasty. In: Scott WN,
editor. Insall & Scott surgery of the knee. Philadelphia:
Elsevier/Churchill Livingstone; 2012. P. 1075–86.
3. Morgan H, Battista V, Leopold SS. Constraint in
primary total knee arthroplasty. J Am Acad Orthop
Surg. 2005; 1(3):515–24.
4. Tigani D, Fosco M, Amendola L, Boriani L. Total knee
arthroplasty in patients with poliomyelitis. Knee.
2009; 1(6):501–6.
5. Jordan L, Kligman M, Sculco TP. Total knee arthroplasty
in patients with poliomyelitis. J Arthroplasty. 2007;
6. Hernández-Vaquero D, Sandoval-Garcí􀆴a MA. Hinged
total knee arthroplasty in the presence of ligamentous
deficiency. Clin Orthop Relat Res. 2010; 4(68):1248–53.
7. Springer BD, Hanssen AD, Sim FH, Lewallen DG. The
kinematic rotating hinge prosthesis for complex knee
arthroplasty. Clin Orthop Relat Res. 2001; 39(2):283–91.
8. Berger JR, Ayyar DR, Kimura I, Kovacs A. Myasthenia
gravis complicating Charcot–Marie–Tooth disease:
report of a case. J Clin Neuroophthalmol. 1985;5(3):76–80.
9. Salemi G, Fierro B, Savettieri G, Maggio M, Lupo I,
Ferrari S, et al. Myasthenia gravis associated with
Charcot–Marie–Tooth neuropathy: report of a case.
Ital J Neurol Sci. 1992; 1(3):431–3.
10. Chen CM, Chang HS, Lyu RK, Tang LM, Chen ST.
Myasthenia gravis and Charcot-Marie-Tooth disease
type 1A: an unusual combination of diseases. Muscle
Nerve. 1997; 20(11):1457-9.
11. Dutkowsky JP. Trophic disorders of joints. In: Crenshaw
AH, editor. Campbell’s operative orthopeadics. 8th ed.
St. Louis: Mosby-Year Book; 1992. P. 2046-7.
12. Drennan DB, Fahey JJ, Maylahn DJ. Important factors
in achieving arthrodesis of the charcot knee. J Bone
Joint Surg Am. 1971; 5(3):1180-93.
13. Soudry M, Binazzi R, Johanson NA, Bullough PG, Insall
JN. Total knee arthroplasty in Charcot and Charcotlike
joints. Clin Orthop. 1986; 208(1):199-204.
14. Mullaji AB, Shetty GM. Deformity correction in total
knee arthroplasty. New York: Springer; 2014. P. 129–35.
Volume 5, Issue 1 - Serial Number 1
January 2017
Pages 58-62
  • Receive Date: 22 April 2016
  • Revise Date: 01 May 2016
  • Accept Date: 16 June 2016
  • First Publish Date: 01 January 2017