Total Knee Arthroplasty Is Safe and Successful in Patients With Klippel-Trénaunay Syndrome

Joshua R. Labott, Cody C. Wyles, Matthew T. Houdek, Megha M Tollefson, David J. Driscoll, William J. Shaughnessy, Rafael J. Sierra

Research output: Contribution to journalArticle

Abstract

Background: Klippel-Trénaunay syndrome (KTS) is a severe vascular malformation that can lead to hypertrophic osteoarthritis. Total knee arthroplasty (TKA) performed in extremities affected with KTS is challenging given the high-risk vascular considerations and occasionally poor bone quality. Methods: We identified 12 patients with KTS who underwent TKA between 1998 and 2017. There were 7 men, mean age 42 years, and mean follow-up was 7 years. Before arthroplasty, 2 patients (17%) had preoperative sclerotherapy. Preoperative vascular studies were done for 9 patients (75%) and included magnetic resonance imaging (n = 7), magnetic resonance angiography (n = 1), and computed tomography angiography (n = 1). A preoperative blood conservation protocol was used for all operations and included the use of tranexamic acid (TXA) in later years. Posterior-stabilized TKA was used in 10 cases and cruciate-retaining TKA was used in 2 cases. Results: At final follow-up, 2 patients (17%) had undergone revision surgery: 1 for infection and 1 for tibial loosening with subsequent arthrofibrosis. Knee Society Scores (36-83, P <.0001) and functional scores (48-84, P =.0007) significantly increased between the preoperative and postoperative period. Likewise at last follow-up, the mean knee range of motion significantly increased (82°-104°, P =.04). Median blood loss for patients who received TXA was 200 mL compared to 275 mL in patients who did not receive TXA (P =.66). Likewise there was no difference (P =.5) in the proportion of patients who required a transfusion between those who received TXA (2/6, 33%) and those who did not (3/6, 50%). Conclusion: In this small series, TKA can lead to significant clinical improvement for patients with KTS. Modern blood management techniques and a careful multidisciplinary care approach render TKA a reasonable option for select patients with KTS. Level of Evidence: Level IV case series, therapeutic.

Original languageEnglish (US)
Pages (from-to)682-685
Number of pages4
JournalJournal of Arthroplasty
Volume34
Issue number4
DOIs
StatePublished - Apr 1 2019

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Knee Replacement Arthroplasties
Tranexamic Acid
Blood Vessels
Preoperative Period
Vascular Malformations
Sclerotherapy
Magnetic Resonance Angiography
Articular Range of Motion
Reoperation
Postoperative Period
Osteoarthritis
Arthroplasty
Knee
Extremities
Magnetic Resonance Imaging
Bone and Bones

Keywords

  • blood management
  • Klippel Trenaunay
  • Klippel-Trénaunay syndrome
  • total knee arthroplasty
  • vascular malformations

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Labott, J. R., Wyles, C. C., Houdek, M. T., Tollefson, M. M., Driscoll, D. J., Shaughnessy, W. J., & Sierra, R. J. (2019). Total Knee Arthroplasty Is Safe and Successful in Patients With Klippel-Trénaunay Syndrome. Journal of Arthroplasty, 34(4), 682-685. https://doi.org/10.1016/j.arth.2018.12.028

Total Knee Arthroplasty Is Safe and Successful in Patients With Klippel-Trénaunay Syndrome. / Labott, Joshua R.; Wyles, Cody C.; Houdek, Matthew T.; Tollefson, Megha M; Driscoll, David J.; Shaughnessy, William J.; Sierra, Rafael J.

In: Journal of Arthroplasty, Vol. 34, No. 4, 01.04.2019, p. 682-685.

Research output: Contribution to journalArticle

Labott, JR, Wyles, CC, Houdek, MT, Tollefson, MM, Driscoll, DJ, Shaughnessy, WJ & Sierra, RJ 2019, 'Total Knee Arthroplasty Is Safe and Successful in Patients With Klippel-Trénaunay Syndrome', Journal of Arthroplasty, vol. 34, no. 4, pp. 682-685. https://doi.org/10.1016/j.arth.2018.12.028
Labott, Joshua R. ; Wyles, Cody C. ; Houdek, Matthew T. ; Tollefson, Megha M ; Driscoll, David J. ; Shaughnessy, William J. ; Sierra, Rafael J. / Total Knee Arthroplasty Is Safe and Successful in Patients With Klippel-Trénaunay Syndrome. In: Journal of Arthroplasty. 2019 ; Vol. 34, No. 4. pp. 682-685.
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abstract = "Background: Klippel-Tr{\'e}naunay syndrome (KTS) is a severe vascular malformation that can lead to hypertrophic osteoarthritis. Total knee arthroplasty (TKA) performed in extremities affected with KTS is challenging given the high-risk vascular considerations and occasionally poor bone quality. Methods: We identified 12 patients with KTS who underwent TKA between 1998 and 2017. There were 7 men, mean age 42 years, and mean follow-up was 7 years. Before arthroplasty, 2 patients (17{\%}) had preoperative sclerotherapy. Preoperative vascular studies were done for 9 patients (75{\%}) and included magnetic resonance imaging (n = 7), magnetic resonance angiography (n = 1), and computed tomography angiography (n = 1). A preoperative blood conservation protocol was used for all operations and included the use of tranexamic acid (TXA) in later years. Posterior-stabilized TKA was used in 10 cases and cruciate-retaining TKA was used in 2 cases. Results: At final follow-up, 2 patients (17{\%}) had undergone revision surgery: 1 for infection and 1 for tibial loosening with subsequent arthrofibrosis. Knee Society Scores (36-83, P <.0001) and functional scores (48-84, P =.0007) significantly increased between the preoperative and postoperative period. Likewise at last follow-up, the mean knee range of motion significantly increased (82°-104°, P =.04). Median blood loss for patients who received TXA was 200 mL compared to 275 mL in patients who did not receive TXA (P =.66). Likewise there was no difference (P =.5) in the proportion of patients who required a transfusion between those who received TXA (2/6, 33{\%}) and those who did not (3/6, 50{\%}). Conclusion: In this small series, TKA can lead to significant clinical improvement for patients with KTS. Modern blood management techniques and a careful multidisciplinary care approach render TKA a reasonable option for select patients with KTS. Level of Evidence: Level IV case series, therapeutic.",
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N2 - Background: Klippel-Trénaunay syndrome (KTS) is a severe vascular malformation that can lead to hypertrophic osteoarthritis. Total knee arthroplasty (TKA) performed in extremities affected with KTS is challenging given the high-risk vascular considerations and occasionally poor bone quality. Methods: We identified 12 patients with KTS who underwent TKA between 1998 and 2017. There were 7 men, mean age 42 years, and mean follow-up was 7 years. Before arthroplasty, 2 patients (17%) had preoperative sclerotherapy. Preoperative vascular studies were done for 9 patients (75%) and included magnetic resonance imaging (n = 7), magnetic resonance angiography (n = 1), and computed tomography angiography (n = 1). A preoperative blood conservation protocol was used for all operations and included the use of tranexamic acid (TXA) in later years. Posterior-stabilized TKA was used in 10 cases and cruciate-retaining TKA was used in 2 cases. Results: At final follow-up, 2 patients (17%) had undergone revision surgery: 1 for infection and 1 for tibial loosening with subsequent arthrofibrosis. Knee Society Scores (36-83, P <.0001) and functional scores (48-84, P =.0007) significantly increased between the preoperative and postoperative period. Likewise at last follow-up, the mean knee range of motion significantly increased (82°-104°, P =.04). Median blood loss for patients who received TXA was 200 mL compared to 275 mL in patients who did not receive TXA (P =.66). Likewise there was no difference (P =.5) in the proportion of patients who required a transfusion between those who received TXA (2/6, 33%) and those who did not (3/6, 50%). Conclusion: In this small series, TKA can lead to significant clinical improvement for patients with KTS. Modern blood management techniques and a careful multidisciplinary care approach render TKA a reasonable option for select patients with KTS. Level of Evidence: Level IV case series, therapeutic.

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