Download PDF
J Knee Surg 2024; 37(13): 910-915
DOI: 10.1055/a-2368-4807
Original Article

Total Knee Arthroplasty in Patients with Cerebral Palsy: A Large Database Analysis

Alexander J. Acuña 
1   Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
,
Robert A. Burnett 
1   Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
,
Conor M. Jones
1   Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
,
Enrico M. Forlenza
1   Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
,
Brett R. Levine
1   Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
,
Craig J. Della Valle
1   Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Cerebral palsy (CP) is a neurodevelopmental condition that can result in altered gait biomechanics, joint dysfunction, and imbalance. The complications associated with total knee arthroplasty (TKA) in patients with CP have not yet been well described. Therefore, our analysis sought to compare the 90-day and 2-year complications following TKA in patients with and without CP. The PearlDiver Mariner database was utilized to identify patients with CP undergoing primary TKA between 2010 and 2020. This cohort was matched 1:4 to a control cohort without neurodegenerative disorders based on age, sex, Elixhauser Comorbidity Index (ECI), tobacco use, obesity, and diabetes. A total of 3,257 patients (657 CP patients 2,600 controls) were included in our final analysis. A multivariable logistic regression analysis was utilized to determine the risk of CP on medical and surgical complications at 90 days and all-cause revision rates at 2 years. Patients with CP had an increased risk of acute kidney injury (odds ratio [OR]: 1.66; 95% confidence interval [CI]: 1.07–2.5; p = 0.019), pneumonia (OR: 5.63; 95% CI: 3.69–8.67; p < 0.001), urinary tract infection (OR: 5.01; 95% CI: 3.85–6.52; p < 0.001), and transfusion (OR: 2.21; 95% CI: 1.50–3.23; p < 0.001). CP patients additionally had a higher incidence of emergency department (ED) visits (OR: 5.24; 95% CI: 3.76–7.32; p < 0.001) and readmissions (OR: 5.24; 95% CI: 2.57–4.96; p < 0.001). There were no differences in rates of periprosthetic joint infection (PJI; OR: 1.23; 95% CI: 0.69–2.10; p = 0.463), surgical site infection (SSI; OR: 0.51; 95% CI: 0.12–1.46; p = 0.463), and reoperation (OR: 1.35; 95% CI: 0.71–2.43; p = 0.339) at 90 days postoperatively. The all-cause revision rates at 2 years were comparable (OR: 1.02; 95% CI: 0.67–1.51; p = 0.927). In this database review, we found that CP patients have a higher risk of medical complications in the acute postoperative period following TKA. The 90-day surgical complication and 2-year revision rates in CP patients were comparable to matched controls.

Keywords

cerebral palsy - total knee arthroplasty - outcomes - complications - neurodegenerative disorders


Publication History

Received: 22 March 2024

Accepted: 16 July 2024

Accepted Manuscript online:
17 July 2024

Article published online:
01 August 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Armstrong RW. Definition and classification of cerebral palsy. Dev Med Child Neurol 2007; 49 (03) 166
    CrossrefPubMedGoogle Scholar
  • 2 Koman LA, Smith BP, Shilt JS. Cerebral palsy. Lancet 2004; 363 (9421): 1619-1631
    CrossrefPubMedGoogle Scholar
  • 3 Carter DR, Tse B. The pathogenesis of osteoarthritis in cerebral palsy. Dev Med Child Neurol 2009; 51 (Suppl. 04) 79-83
    CrossrefPubMedGoogle Scholar
  • 4 Perry J, Antonelli D, Ford W. Analysis of knee-joint forces during flexed-knee stance. J Bone Joint Surg Am 1975; 57 (07) 961-967
    CrossrefPubMedGoogle Scholar
  • 5 Choi Y, Lee SH, Chung CY. et al. Anterior knee pain in patients with cerebral palsy. Clin Orthop Surg 2014; 6 (04) 426-431
    CrossrefPubMedGoogle Scholar
  • 6 Horstmann HM, Hosalkar H, Keenan MA. Orthopaedic issues in the musculoskeletal care of adults with cerebral palsy. Dev Med Child Neurol 2009; 51 (Suppl. 04) 99-105
    CrossrefPubMedGoogle Scholar
  • 7 de Morais Filho MC, Neves DL, Abreu FP, Juliano Y, Guimarães L. Treatment of fixed knee flexion deformity and crouch gait using distal femur extension osteotomy in cerebral palsy. J Child Orthop 2008; 2 (01) 37-43
    CrossrefPubMedGoogle Scholar
  • 8 Chang WN, Tsirikos AI, Miller F. et al. Distal hamstring lengthening in ambulatory children with cerebral palsy: primary versus revision procedures. Gait Posture 2004; 19 (03) 298-304
    CrossrefPubMedGoogle Scholar
  • 9 Stout JL, Gage JR, Schwartz MH, Novacheck TF. Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy. J Bone Joint Surg Am 2008; 90 (11) 2470-2484
    CrossrefPubMedGoogle Scholar
  • 10 Nieuwenhuys A, Papageorgiou E, Pataky T, De Laet T, Molenaers G, Desloovere K. Literature review and comparison of two statistical methods to evaluate the effect of botulinum toxin treatment on gait in children with cerebral palsy. PLoS One 2016; 11 (03) e0152697
    CrossrefPubMedGoogle Scholar
  • 11 Ubhi T, Bhakta BB, Ives HL, Allgar V, Roussounis SH. Randomised double blind placebo controlled trial of the effect of botulinum toxin on walking in cerebral palsy. Arch Dis Child 2000; 83 (06) 481-487
    CrossrefPubMedGoogle Scholar
  • 12 Moon AS, Pinto MC, Cichos KH, McGwin Jr G, Ponce BA, Ghanem ES. Total joint arthroplasty in patients with cerebral palsy. J Am Acad Orthop Surg 2020; 28 (04) 171-177
    CrossrefPubMedGoogle Scholar
  • 13 Houdek MT, Watts CD, Wyles CC, Trousdale RT, Milbrandt TJ, Taunton MJ. Total knee arthroplasty in patients with cerebral palsy: a matched cohort study to patients with osteoarthritis. J Am Acad Orthop Surg 2017; 25 (05) 381-388
    CrossrefPubMedGoogle Scholar
  • 14 Pomeroy E, Fenelon C, Murphy EP, Staunton PF, Rowan FE, Cleary MS. A systematic review of total knee arthroplasty in neurologic conditions: survivorship, complications, and surgical considerations. J Arthroplasty 2020; 35 (11) 3383-3392
    CrossrefPubMedGoogle Scholar
  • 15 Cichos KH, Lehtonen EJ, McGwin Jr G, Ponce BA, Ghanem ES. Inhospital complications of patients with neuromuscular disorders undergoing total joint arthroplasty. J Am Acad Orthop Surg 2019; 27 (11) e535-e543
    CrossrefPubMedGoogle Scholar
  • 16 Alshryda S, Wright J. Hip dislocation and subluxation in cerebral palsy. Class Pap Orthop 2014; 863 (04) 579-580
    CrossrefPubMedGoogle Scholar
  • 17 Fillingham YA, Ramkumar DB, Jevsevar DS. et al. The efficacy of tranexamic acid in total knee arthroplasty: a network meta-analysis. J Arthroplasty 2018; 33 (10) 3090-3098.e1
    CrossrefPubMedGoogle Scholar
  • 18 Skertich NJ, Ingram ME, Sullivan GA. et al. Postoperative complications in pediatric patients with cerebral palsy. J Pediatr Surg 2022; 57 (03) 424-429
    CrossrefPubMedGoogle Scholar
  • 19 Moore HG, Gardezi M, Burroughs PJ, Rubin LE, Frumberg DB, Grauer JN. Total hip arthroplasty in patients with cerebral palsy: a matched comparison of 90-day adverse events and 5-year implant survival. J Arthroplasty 2021; 36 (10) 3534-3537
    CrossrefPubMedGoogle Scholar
  • 20 Ryakitimbo A, Philemon R, Mazuguni F, Msuya L. Prevalence and antimicrobial sensitivity pattern of urinary tract infection among children with cerebral palsy, Moshi, Tanzania. Pediatric Health Med Ther 2018; 9: 59-65
    CrossrefPubMedGoogle Scholar
  • 21 Fields M, Lee NJ, McCormick K. et al. A national analysis on complications and readmissions for adult cerebral palsy patients undergoing primary spinal fusion surgery. Eur Spine J 2022; 31 (03) 718-725
    CrossrefPubMedGoogle Scholar
  • 22 Pantzar-castilla EHS, Wretenberg P, Riad J. Erratum. Acta Orthop 2021; 92 (04) 500
    CrossrefPubMedGoogle Scholar