Total Knee Arthroplasty in Patient with Paraplegia after Spinal Cord Injury. What Factors Should be Considered before a Procedure? A Case Report and Review of Literature

Abstract

The clinical management of paraplegic patients is more complex than inable-bodied subjects. Spinal cord injury (SCI) affects younger, activepeople more often than the elderly during high-energy fall or trafficaccidents. In order to return to work after suffering an SCI, patientsneed to regain their functional independence, especially their abilityto drive. The literature lacks strong evidence addressing the surgicalsolutions in severe knee arthrosis in paralyzed patients after SCI. Wepresent a favourable outcome of total knee arthroplasty (TKA) of a stiffknee in extension in a man with T12 grade C paraplegia after SCI. Wedescribe an effective rehabilitation protocol after knee arthroplasty inpatient with damage to the spinal cord. Several factors should be takeninto account before performing surgery:1. ability of regaining some of spinal cord locomotor function throughintensive gait rehabilitation in SCI patients,2. presence of muscle imbalance and knee contractures combined with arisk of bone fracture resulting from intensive postoperativerehabilitation,3. the impaired microvasculature of the skin and subcutaneous tissuesand increased risk of occlusion occurrence of the capillaries and smallvessels of the leg,4. higher prevalence of secondary infections via urinary entry sites inpatients after SCI,5. patient's strong determination and willingness to undergo thearthroplasty procedure. TKA might be considered in selected paralyzedpatients after SCI, especially in those with severe arthrosis as well assignificant knee contractures. Our study reveals the advantage ofperforming TKA in improving functional state in patients with cordinjury.