[Ortho] Постсифилитическая артропатия

[Maxim Agalakov]

из Campbell:
If a neuropathic knee is painless, bracing is the treatment of choice; 
however, many patients have disabling pain, and operative treatment 
should be considered for these patients. Controversy still surrounds the 
inclusion of neuropathic arthritis as an indication for total knee 
arthroplasty. Several authors reported success with constrained and 
semiconstrained prostheses in neuropathic arthropathy, but the number of 
patients has not been large, and the length of follow-up has been short. 
Hui and Fitzgerald reported generally good results in five knees with 
neuropathic arthritis at an average of 3.3 years after hinged total knee 
arthroplasty. Matthews and Kaufer performed seven spherocentric total 
knee arthroplasties in four patients with clinical or radiographic 
evidence of neuropathic arthropathy. Within an average of 4 years, 
aseptic loosening developed in one patient, and instability developed in 
another. Soudry et al. reported good results at an average 3 years after 
surgery in nine knees with Charcot and Charcot-like joints using 
posterior stabilized condylar-type prostheses, most of which were 
custom-made to compensate for femoral or tibial bone deficits. Many 
authors have reported failure of total knee arthroplasty in patients 
with neuropathic arthropathy, most of which occurred with unconstrained 
prostheses. Kim, Kim, and Oh reported that at 5-year follow-up only 10 
(53%) of 19 total knee arthroplasties in patients with Charcot 
arthropathy were satisfactory; serious complications were frequent. 
Parvizi, Marrs, and Morrey reported improvements in pain and function at 
7 years after 40 total knee arthroplasties in 29 patients with Charcot 
joints; however, methods usually reserved for complex revision total 
knee arthroplasty were required in most of the procedures. Our limited 
experience with total knee arthroplasty in neuropathic knee joints also 
has been disappointing.
Although sometimes difficult to achieve, arthrodesis is considered the 
treatment of choice for painful neuropathic arthritis of the knee. 
Techniques of arthrodesis are described in Chapter 3, but some general 
principles should be kept in mind for patients with neuropathic knee 
joints, as follows: (1) complete débridement of all hypertrophic 
synovium, (2) careful carpentry of apposing bone surfaces, (3) strong 
internal fixation, and (4) adequate external support after arthrodesis
Maxim Agalakov