Survivorship of total knee arthroplasty in poliomyelitis patients: long-term results from the R.I.P.O. registry and single-institution retrospective study.

Abstract

The survival of total knee arthroplasty (TKA) in patients with poliomyelitis remains a debated topic due to the high recurrence of postoperative genu recurvatum. This study aims to report the long-term survival of TKA in patients with poliomyelitis, using data from the Italian Register of Prosthetic Implantology. A registry-based population study was conducted, utilizing data from the Emilia Romagna orthopedic arthroplasty implants registry (RIPO - Registro Implantologia Protesica Ortopedica). The cohort consisted of 71 patients with poliomyelitis-related arthritis who underwent TKA. The study assessed and analyzed demographic data, implant type, fixation method, insert type, and level of constraint. Additionally, variations in preoperative and postoperative both clinical and functional Knee Society Scores (KSS) were collected. Eight implants required revision surgery (16%), and three patients died (6.1%), resulting in a 10-year survival rate of 86.6% and a 15-year survival rate of 53.9%. Aseptic loosening was the primary cause of revision, accounting for 37.5% of failures, followed by insert wear (25%). No statistically significant correlation was found between the level of constraint and implant survival (p=0.0887, log-rank). Both the clinical and functional KSS improved postoperatively. TKA is a viable alternative to knee arthrodesis and, in properly selected patients, might represent the first-choice treatment for articular degeneration due to its high survivorship. Despite the complexity of these cases, TKA can effectively alleviate articular pain, instability, and angular deviation, thereby preserving knee functionality.