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

1 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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    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