PMC8437648_01
The picture of the PD patient standing on and off. The picture shows the appearance of the patient with PD. She managed to remain standing and walk leaning the body to her left side. The postural deformities:Pisa syndrome and bent posture:became noticeable when PD was off.
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She had Pisa syndrome and scoliosis that were postural deformities of the trunk as symptoms of her PD (Figure 1).
Radiographs of total spinal alignment. (a) Preoperative radiograph revealing lumbar spinal alignment in a supine position. (b) Postoperative radiograph of L1-L4 PLIF revealing lumbar spinal alignment in a supine position. (c) Radiograph showing total spinal alignment in a standing position. Pisa syndrome: the leaning of the body exacerbated when walking or standing but improved in the supine position.
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Her medical history included L1-L4 PLIF for lumbar degenerative spondylolisthesis and scoliosis to get rid of her leg pain, which was performed in another hospital one month prior to the gradual onset of her left knee pain (Figures 2(a) and 2(b)).
Preoperative radiographs of the left knee. (a) Radiograph at the first visit to our hospital shows Kellgren-Lawrence grade II and mild osteoarthritis of the lateral joint surface. (b) Radiograph at 1 month later shows Kellgren-Lawrence classification grade IV and severe valgus osteoarthritis.
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A radiograph revealed moderate lateral osteoarthritis of the knee (Kellgren-Lawrence classification grade II) (Figure 3(a)). After repeated swelling and subsidence of the knee, the radiograph revealed progression to Kellgren-Lawrence grade IV in only 1 month (Figure 3(b)).
MRI of the left knee. Magnetic resonance image revealing partial depression of the joint surface including shredded ossicles and substantial amounts of synovial fluid. The findings were similar to those of osteomyelitis.
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T2-weighted coronal image revealed diffuse high-signal intensity, which suggested extensive spreading edema of the bone marrow and soft tissue (Figure 4). The change was considered to be caused by a SIF.
TKA. (a) Intraoperative photograph showing that the cartilage of the lateral joint surface of her left knee was scooped out and eburnated partially. (b) Postoperative radiographs of left TKA using a semiconstrained prosthesis.
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The cartilage of the lateral joint surface was scooped out and partially eburnated (Figure 5(a)). TKA was performed using a stemmed semiconstrained prosthesis (Attune Revision, DePuy Synthes, Warsaw, IN) because of concern for the failure of the medial collateral ligament caused by severe bone fragility in the medial epicondyle of the femur (Figures 5(b) and 5(c)).
Total alignment of the lower extremity while standing. (a) Radiograph revealing preoperative total alignment of the lower extremity in a standing position. (b) Radiograph revealing postoperative total alignment of the lower extremity in a standing position.
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TKA and resection of the adductor longus tendon of the hip. The preoperative hip-knee-ankle angle (HKA angle) (-16 degrees while standing) was corrected to postoperative HKA angle (-2 degrees; positive values indicate the varus direction) (Figure 6).