New Mayo Study: TKA in Patients with Cerebral Palsy

As adults with cerebral palsy (CP) age, they develop arthritis and other musculoskeletal issues at a higher rate than adults without CP. Sadly, information related to diagnosing and treating musculoskeletal problems in the CP adult is virtually non-existent in the research community.

A team of Mayo Clinic researchers in Rochester, Minnesota decided to step into the breach and investigate the experience of treating the CP adult with total knee arthroplasty (TKA).

Their work, “Total Knee Arthroplasty in Patients With Cerebral Palsy: A Matched Cohort Study to Patients With Osteoarthritis,” appears in the May 2017 edition of the Journal of The American Academy of Orthopaedic Surgeons.

The authors wrote, “Currently, few data examine the use of TKA in patients with cerebral palsy. Over a 28-year period, 15 TKAs in patients with a diagnosis of CP were identified. The cohort was 53% men, with a mean age of 58 years. Patients with CP were matched 1:2 based on age, sex, body mass index, and year of surgery with a group of patients undergoing TKA for osteoarthritis.”

Matthew T. Houdek, M.D., an orthopedic surgeon at Mayo Clinic, was a co-author on the study. He told OTW, “I saw a patient in clinic with CP who needed a total knee replacement and realized there really was no literature on the outcomes of treatment.”

The authors found no difference in implant survival or revision surgery between groups. “All patients were ambulatory postoperatively, and significant increases were noted in the Knee Society score and functional assessment,” write the authors.

Dr. Houdek commented to OTW, “We wanted to point out with the results of the study that in patients with CP the surgeries are technically demanding since there are often issues with the extensor mechanism. However, following a TKA patients have substantial pain relief; this surgery allows some of these patients to become more independent in terms of their ability to ambulate.”

“Patients with CP are frequently treated by pediatric orthopedic surgeons; however, as the patients get older (too old for their pediatric orthopedic surgeon) they can develop hip and knee pain and degenerative changes. Once these changes develop they should undergo a multimodal non-operative pain control program, and if this fails they should be referred to a subspecialty adult reconstruction surgeon to consider an arthroplasty procedure.”

“A focused exam on the knee and x-rays of the knee, hip (pain can be referred) and full length standing films are needed. If there is an equivocal exam, the surgeon can consider an injection of the knee with an anesthetic to see if the pain is relieved.”