A Systematic Review of Total Knee Arthroplasty in Neurological Conditions: Survivorship, Complications and Surgical Considerations

Abstract Background Patients with neurological disorders present a unique set of challenges for knee surgeons due to contractures, muscle weakness, spasticity and ligament instability. The primary purpose of this review was to report the outcomes of TKA in these patients including survivorship, complications and surgical considerations. Methods We performed a systematic review of articles using PubMed, Cochrane Central, EMBASE and Google Scholar. All studies reporting outcomes of TKA in patients with Parkinson’s disease, multiple sclerosis, poliomyelitis, Charcot joint, spina bifida, stroke and cerebral palsy were included. Results 38 studies were included: 22 studies (461 patients) reported PROMs and 24 studies (510 patients) reported survivorship. All 38 studies reported complication rates. TKA resulted in an improvement in functional outcome in all series. Complication rate was higher in patients with neurological conditions. Of studies reporting survivorship, mean follow up ranged from 1 – 12 years with survivorship from 66-100%. All levels of implant constraint were reported without consensus. Limited rehabilitative data exists. Conclusions TKA in patients with neurological disorders improves symptoms and function but carries significant risk. This review helps surgeons pre-operatively counsel their patients in an informed manner. Careful planning, perioperative care and appropriate implant selection may mitigate risk of complication.