Triple Deformity of Knee Joint
Nowadays knee-related problems are arising in large numbers regardless of the age group. In elders, joint pain has become quite common and they regularly visit doctors to find a cure for this. Triple Deformity of Knee Joint is one such condition prevailing nowadays.
Triple Deformity of the knee joint could be otherwise called the tuberculosis of the knee joint. A triple deformity that is valgus, external rotation, flexion deformity of the knee with posterior subluxation of the tibia is usually seen in tuberculosis of knee and rheumatoid arthritis or in post traumatic incompletely reduced old neglected dislocated knees. Many people are still confused about the reason behind such a condition. In this blog, we will discuss the causes, features and preventive measures of Triple Deformity of the knee joint.
Causes of Triple Deformity of knee joint
Triple Deformity of knee joints is commonly seen in aged people. There are certain causes or problems that lead to this condition. Let’s evaluate those causes
Tuberculosis of the knee joint: Tuberculosis is considered the most common cause of the triple deformity of the knee joint. Tuberculosis of the knee joint is mainly mono-arthritis, that is, it mostly involves only one joint. Tuberculosis is basically a systemic disease and spread to joints by a hematogenous route that is transmitted through blood. Mycobacterium tuberculosis is the causative organism.
Rheumatoid arthritis of the knee joint: Rheumatoid arthritis (RA) is a type of arthritis where your immune system attacks healthy tissues in your joints. It usually affects the joints in the hands and feet, but it can affect the knees and other joints. But how does it affect the knee, let’s have a look. The Immune cells in the body target the synovial membrane that lines the knee joint. This membrane protects the cartilage, ligaments, and other tissues of the knee joint. It also makes synovial fluid, which lubricates the joint to allow for smooth movement and causes the membrane to swell. This causes pain from the inflammation of the tissue. Knee movement is also limited as the swollen membrane takes up more space in the knee area.
Post-traumatic Arthritis: Post-traumatic arthritis is a condition triggered by acute joint trauma that can lead to osteoarthritis or chronic inflammatory arthropathies. Joint injuries, with or without associated disruption of the articular surface, frequently lead to a progressive process of a severe debilitating condition known as acute post-traumatic arthritis (PTA). PTA can occur at any age, in any joints, and may develop from any kind of acute physical trauma, such as sports, vehicle accident, fall or military injury. Although a single trauma may sometimes be sufficient to induce arthropathy, repeated injuries and excess body weight are known to increase the risk for PTA.
Old Neglected Dislocated Knee: Old neglected dislocation of the knee joint is a rare injury. Any orthopaedic surgeon would have faced only a few cases of unreduced neglected dislocation in his lifetime practice. acute knee dislocations are either reduced spontaneously at the accident site or reduced in the emergency department under sedation by closed manipulation. There are case reports of old neglected knee dislocations ranging from four weeks to 15 years.
Poliomyelitis: Polio is a highly infectious disease caused by a virus. It invades the nervous system and can cause total paralysis in a matter of hours. The virus is transmitted by person-to-person spread mainly through the faecal-oral route. It can badly affect the joints and particularly the knee joints.
Haemophiliac: The most common complication of haemophilia is a joint disease. A joint is an area where two bones come together. People with haemophilia can bleed into the joint space after an injury or, at times, without an obvious cause. The pressure of blood filling the joint cavity causes significant pain and can lead to chronic swelling and deformity. Joint damage can occur after repeated bleeding into the same joint or after one serious joint bleed. The joints typically affected include the elbows, ankles and knees.
Symptoms of triple deformity of knee joint
Flexion of the knee- Flexion is the medical term for bending an arm or leg. It’s a physical position that decreases the angle between the bones of the limb at a joint. It occurs when muscles contract and move your bones and joints into a bent position
Posterolateral subluxation of the tibia- Recurrent anterior subluxation of the lateral tibial plateau is a common type of chronic knee instability resulting from trauma
External rotation of tibia over femoral condyles – With femoral anteversion, the knees point inward while walking. When femoral anteversion is associated with external tibial torsion (an outward twist of the tibia or lower leg bone), there can be knee problems such as patellar (knee cap) instability and pain, particularly when the child reaches the adolescent age range.
Wasting of muscles around thigh- Lack of physical activity due to an injury or illness, poor nutrition, genetics, and certain medical conditions can all contribute to muscle atrophy. Muscle atrophy can occur after long periods of inactivity. If a muscle does not get any use, the body will eventually break it down to conserve energy
Sinus formation discharge- A tunnelling wound or sinus tract is a narrow opening or passageway extending from a wound underneath the skin in any direction through soft tissue and results in dead space with potential for abscess formation.
Synovial swelling- Knee synovitis occurs when the synovial membrane, which lines and lubricates the knee joint, becomes inflamed. Synovitis may be caused by another condition, such as Rheumatoid Arthritis or gout, or may develop on its own. This lining can become inflamed, causing pain and stiffness in the joint
Knee effusion- Knee effusion occurs when excess synovial fluid accumulates in or around the knee joint. It has many common causes, including Arthritis, injury to the ligaments or meniscus, or fluid collecting in the bursa, a condition known as perpetually bursitis.
Local rise of temperature- The pain in joints especially can lead to the rise in temperature of the human body and it may lead to fever.
Joint line tenderness- The joint line tenderness test is used to screen for sensitivity related to meniscal injuries. The test can be used if the pain is localised to either the medial or lateral aspect of the joint, this is usually due to pathology of either the articular joint cartilage or the medial or lateral meniscus
Restricted knee joint movement- Arthritis is the most common cause of limited knee mobility. If knee motion becomes restricted following an injury, the probable cause is injury-related swelling or a torn structure in the knee
Regional lymphadenopathy- Lymphadenopathy is usually caused by a bacterial, viral, or fungal infection. Rheumatoid arthritis causes regional lymphadenopathy problems in the knee
What is the treatment of triple deformities of the knee joint?
The Treatment of triple deformities of the knee joint has different methods. The process includes the treatment of the respective causes or aetiologies along with deformity correction. Synovitis is the common problem either with tuberculosis or rheumatoid arthritis. As a result of which joint effusion may be noted. Subsequently, joint effusion is aspirated if patellar tap which indicates fluid in the supra-patellar joint is positive. As per the recent guidelines for tuberculosis infection, Anti-tubercular drugs are used. For rheumatoid infections.disease-modifying agents are used.
As it involves deformity and joint contracture, skeletal traction will be useful to prevent further deformity and contracture. 90-90 skeletal traction is applied for 4 to 6 weeks. It is usually continued for 6 weeks. Russell’s traction is used for triple deformity mostly in flexion deformity or posterior subluxation. Another used treatment method is total knee replacement. Even though it’s costly, it’s beneficial. Total knee replacement is considered challenging with the fact that the knee is found subluxate in triple deformity of the knee joint. Orthopaedic surgeons aimed at reducing the subluxation first before the knee arthroplasty. Postoperatively gaining the knee flexion is considered as a major objective for rehabilitation.
For anyone who has queries related to triple deformity, it’s better to contact an Orthopaedic Specialist and take advice from them. Dr. Madhu Thumu is one of the best orthopaedic surgeon with an experience of almost 15 years and could help you with knee problems.