From January 1984 to January 1994, fourteen total knee arthroplasties were performed in eleven patient with the diagnosis of the neuropathic arthropathy. Three patients had bilateral procedures. There were ten right and four left knees. The
patients
were evaluated by clinical examination, radiographs and the HSS Knee Rating Scale. At the time of surgery, the average age of patients was 60.5 years(range, 46-71 years). The patients were evaluated in average of four years and none months(range,
1 year 5 months-10 years 4 months) from the time of surgery. The prostheses used were Link type Endo model in nine knees, Insall-Burstein in two, Miller-Gallante in two and PFC posterior stabilized type in one. The diagnosis of Charccot´s joints was
made
by
the clinical, pathologic, and serologic findings. All patients had positive reaction in VDRL, TPHA test. All of the cases demonstrated histological features that were consistent with those of Charcot´s joints. Chronic inflammatory synovitis with
organizing fibrosis was noted in all cases. Hyperplastic synovium with bone detritus was also seen. Therefore all cases were classified as classical Charcot´s joints. We corrected bone loss and severe joint instability with autogenous or
homogenous
bone
grafting and ligament balancing. The-HSS Knee Rating Scale scores increased from an average of 52.7 points preoperatively to an average of 92.1 postoperatively. The mean increase of total arc of motion after surgery was 20 degree. Three of
fourteen
knees demonstrated the posterior dislocation of prosthesis, at postoperative two months, six months and two years. We performed closed reduction in two patients and open reduction in one patient. One cases of late infection due to hematogenous
spread
was treated with open drainage and intravenous antibiotics Because of most patients of neuropathic joint has severe knee instability secondary to ligament laxity and bone loss, total knee arthroplasty in these patients muse patients must be
performed
with proper ligament balancing, adequate augmentation of severe bony defects, and use of constrained type prostheses.
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