# Revision total knee arthroplasty with Charcot-Marie-Tooth disease - a case report

## TL;DR

A patient with Charcot-Marie-Tooth disease experienced early failure of a knee implant, requiring revision surgery with a specialized implant for better stability.

## Contribution

This case report highlights the need for tailored surgical approaches and close monitoring in CMT patients undergoing knee replacement.

## Key findings

- A 72-year-old CMT patient had early implant loosening ten years after primary TKA.
- Revision using a rotating-hinge TKA with tibial augmentation led to successful recovery.
- CMT-related instability may require constrained implants to prevent early failure.

## Abstract

Charcot-Marie-Tooth (CMT) disease is a rare hereditary neuropathy characterized by progressive distal muscle weakness and altered gait biomechanics. Total knee arthroplasty (TKA) in CMT patients can be challenging, as little is known about long-term outcomes. This case highlights the need for pre-operative planning and structured follow-up of patients with CMT who underwent TKA, as loosening might occur at an early stage.

A 72-year-old woman with advanced CMT disease presented with disabling pain and multidirectional instability ten years after a primary TKA. Radiographic evaluation revealed severe aseptic loosening and extensive metaphyseal bone loss. Revision surgery was performed in a one-stage approach using a rotating-hinge TKA with tibial metaphyseal augmentation. The patient experienced excellent recovery and functional improvement. One-stage revision to a rotating-hinge TKA demonstrated a favourable outcome at 3 years.

Patients with CMT may present with multiplanar joint instability and abnormal gait, placing increased stress on standard condylar implants and accelerating loosening. In such cases, standard implants may not be appropriate. Early consideration of stemmed or constrained implants may improve stability and durability. Revision surgery may be further complicated by bone loss and instability, warranting the use of rotating-hinged TKA systems. Close postoperative monitoring is critical to detect complications early in this high-risk population.

CMT-related neuromuscular dysfunction may predispose to early TKA failure. This case underlines the importance of preoperative planning and long-term follow-up. When major bone loss and instability are present, revision to a rotating-hinged TKA offers a reliable and durable solution.

•Considering the use of stems during primary surgical planning could potentially improve implant stability and reduce the risk of early failure in this patient population.•Close follow-up of CMT patients who underwent TKA is crucial in order to detect complications early.•In the presence of major bone loss and instability, revision to a rotating-hinged TKA offers a valid result.

Considering the use of stems during primary surgical planning could potentially improve implant stability and reduce the risk of early failure in this patient population.

Close follow-up of CMT patients who underwent TKA is crucial in order to detect complications early.

In the presence of major bone loss and instability, revision to a rotating-hinged TKA offers a valid result.