A COST EFFECTIVE TECHNIQUE TOTAL KNEE REPLACEMENT TREATMENT FOR A PATIENT WITH CHARCOT MARRIE TOOTH DISEASE, A CASE REPORT AND LITERATURE REVIEW
Authors:   Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia., Alageel Musab , S. Alshaygy Ibrahim ,   Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,   College of Medicine, Alfaisal University, Riyadh, Saudi Arabia., Hashim Ahmed ,   Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia., Ahmed Alsehibani Yazeed ,   Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia., Alabdulkarim Nouf ,   Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia., Khalid Addweesh Abdurahman ,   College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia., Nader Alkhateb Munib ,   College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia., Abdulaziz Alrassan Lina ,   General Administration of Health Facilities Environment, Ministry of Health, Riyadh, Saudi Arabia., Aljassir Fawzi ,   Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Published: January 2025

Introduction:Charcot-Marie-Tooth disease affects about 1 in 2,500 individuals. it causes progressive muscle atrophy and sensory loss, predominantly in the distal extremities. CMT manifests early in childhood or adolescence, characterized essentially by features of an unstable gait and a unique type of neurogenic arthropathy known as Charcot joint. Severe muscle weakness and instability is seen in advanced cases of the diseases, Charcot joints used to be considered a contraindication for Total Knee Replacement (TKR) due to ligamentous laxity which leads to joint instability. The treatment used to be arthrodesis of the joint and with time rotating stem prosthesis for knee with severe ligamentous laxity or proximal tibia prosthesis in cases of destructive knee joint. In this case we are presenting a rare case which treated by acost effective technique to overcome the knee joint instability.

Case Presentation: We present the case of a 75-year-old female with CMTand multiple co-morbidities. She presented with history of pain in both knees, more in the right knee. She didnt respond to conservative treatment. Her physical examination revealed neuromuscular weakness, tenderness in both knees and restricted range of motion. The X-rays confirmed advanced osteoarthritis without destructive knee joint or subluxation. Preoperatively, the patient underwent physiotherapy to improve range of motion.She was subsequently taken for a right TKR using a semi-constrained system. To overcome the knee instability, a tibia size was 2 with tibia insert size 10 mm and tibia stem 25mm are used and the femur size was 3. Intraoperatively patient showed stable valgus and varus test. Postoperatively, the patient began mobilization and range-of-motion exercises on the first day without instability. Two weeks later, she was ambulating independently with a walker, had significant pain improvement, and nearly full range of motion.

Conclusion: The positive outcome in this patient suggests that using a semi-constrained TKR can be successful and cost-effective solution for managing Charcot knee in individuals with CMT, leading to significant improvements in pain and function. This is the first reported use of a Semi-constrained TKR instead of a rotating hinge to treat Charcot knee. However, further studies with long-term outcomes are needed to better understand its significance in Charcot knee secondary to CMT.