Rapid Destructive Arthropathy of the Knee in Parkinson’s Disease with Pisa Syndrome: A Case of Knee-Spine Syndrome
The changes occurring in knee osteoarthritis often cause alterations in the spinal loading condition, which further lead to degenerative changes. This close relationship of the knee and spine has been reported as knee-spine syndrome. A 60-year-old woman with Parkinson’s disease (PD; Hoehn-Yahr stage...
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Wiley
2021-01-01
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| Series: | Case Reports in Orthopedics |
| Online Access: | http://dx.doi.org/10.1155/2021/6622445 |
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| author | Hirokazu Takai Masato Kitajima Seiko Takai Tomoki Takahashi Ken-ichi Katsura Makoto Tokunaga Susumu Watanabe |
| author_facet | Hirokazu Takai Masato Kitajima Seiko Takai Tomoki Takahashi Ken-ichi Katsura Makoto Tokunaga Susumu Watanabe |
| author_sort | Hirokazu Takai |
| collection | DOAJ |
| description | The changes occurring in knee osteoarthritis often cause alterations in the spinal loading condition, which further lead to degenerative changes. This close relationship of the knee and spine has been reported as knee-spine syndrome. A 60-year-old woman with Parkinson’s disease (PD; Hoehn-Yahr stage IV) had severe knee pain with moderate lateral osteoarthritis of the knee (Kellgren-Lawrence classification grade II). Conservative therapy had no effect at all, and the knee developed destructive osteoarthritis rapidly without any traumatic episodes. The radiographic findings progressed to Kellgren-Lawrence grade IV within a month. Magnetic resonance imaging revealed partial depression of the joint surface, including shredded ossicles and substantial amounts of synovial fluid. The imaging findings were considered to be caused by a subchondral insufficiency fracture (SIF). Total knee arthroplasty was performed using a semiconstrained prosthesis. The alignment of her lower extremity improved, and the patient could walk without knee pain. The patient had Pisa syndrome, a lateral flexion of the trunk, which is a postural deformity of the trunk secondary to long-standing PD. The postural deformity in PD is not based on spinal deformity itself but on the loss of postural reflexes and the imbalance of muscle tonus. Her left knee pain appeared 1 month after L1-L4 posterior lumbar interbody fusion (PLIF) as the Pisa syndrome to her left side worsened. The more the trunk tilts to the lateral side, the center of the gravity axis will shift and pass through more lateral points of the knee and result in higher knee load. The stress concentration from the spine to the lateral joint of the knee caused lateral knee osteoarthritis, namely, knee-spine syndrome. When patients undergo correction surgery for adult spinal disorder with impairment of postural reflexes, they need to be followed up carefully regarding not only the spinal alignment but also the lower extremities. |
| format | Article |
| id | doaj-art-a66eee42205346d18a0698c8355324e9 |
| institution | Kabale University |
| issn | 2090-6749 2090-6757 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Orthopedics |
| spelling | doaj-art-a66eee42205346d18a0698c8355324e92025-02-03T05:44:45ZengWileyCase Reports in Orthopedics2090-67492090-67572021-01-01202110.1155/2021/66224456622445Rapid Destructive Arthropathy of the Knee in Parkinson’s Disease with Pisa Syndrome: A Case of Knee-Spine SyndromeHirokazu Takai0Masato Kitajima1Seiko Takai2Tomoki Takahashi3Ken-ichi Katsura4Makoto Tokunaga5Susumu Watanabe6Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, JapanDepartment of Orthopaedic Surgery, Kumamoto Kinoh Hospital, JapanDepartment of Orthopaedic Surgery, Kumamoto Kinoh Hospital, JapanDepartment of Orthopaedic Surgery, Kumamoto Kinoh Hospital, JapanDepartment of Rehabilitation Medicine & Neurology, Kumamoto Kinoh Hospital, Kumamoto, Kumamoto, JapanDepartment of Rehabilitation Medicine & Neurology, Kumamoto Kinoh Hospital, Kumamoto, Kumamoto, JapanDepartment of Rehabilitation Medicine & Neurology, Kumamoto Kinoh Hospital, Kumamoto, Kumamoto, JapanThe changes occurring in knee osteoarthritis often cause alterations in the spinal loading condition, which further lead to degenerative changes. This close relationship of the knee and spine has been reported as knee-spine syndrome. A 60-year-old woman with Parkinson’s disease (PD; Hoehn-Yahr stage IV) had severe knee pain with moderate lateral osteoarthritis of the knee (Kellgren-Lawrence classification grade II). Conservative therapy had no effect at all, and the knee developed destructive osteoarthritis rapidly without any traumatic episodes. The radiographic findings progressed to Kellgren-Lawrence grade IV within a month. Magnetic resonance imaging revealed partial depression of the joint surface, including shredded ossicles and substantial amounts of synovial fluid. The imaging findings were considered to be caused by a subchondral insufficiency fracture (SIF). Total knee arthroplasty was performed using a semiconstrained prosthesis. The alignment of her lower extremity improved, and the patient could walk without knee pain. The patient had Pisa syndrome, a lateral flexion of the trunk, which is a postural deformity of the trunk secondary to long-standing PD. The postural deformity in PD is not based on spinal deformity itself but on the loss of postural reflexes and the imbalance of muscle tonus. Her left knee pain appeared 1 month after L1-L4 posterior lumbar interbody fusion (PLIF) as the Pisa syndrome to her left side worsened. The more the trunk tilts to the lateral side, the center of the gravity axis will shift and pass through more lateral points of the knee and result in higher knee load. The stress concentration from the spine to the lateral joint of the knee caused lateral knee osteoarthritis, namely, knee-spine syndrome. When patients undergo correction surgery for adult spinal disorder with impairment of postural reflexes, they need to be followed up carefully regarding not only the spinal alignment but also the lower extremities.http://dx.doi.org/10.1155/2021/6622445 |
| spellingShingle | Hirokazu Takai Masato Kitajima Seiko Takai Tomoki Takahashi Ken-ichi Katsura Makoto Tokunaga Susumu Watanabe Rapid Destructive Arthropathy of the Knee in Parkinson’s Disease with Pisa Syndrome: A Case of Knee-Spine Syndrome Case Reports in Orthopedics |
| title | Rapid Destructive Arthropathy of the Knee in Parkinson’s Disease with Pisa Syndrome: A Case of Knee-Spine Syndrome |
| title_full | Rapid Destructive Arthropathy of the Knee in Parkinson’s Disease with Pisa Syndrome: A Case of Knee-Spine Syndrome |
| title_fullStr | Rapid Destructive Arthropathy of the Knee in Parkinson’s Disease with Pisa Syndrome: A Case of Knee-Spine Syndrome |
| title_full_unstemmed | Rapid Destructive Arthropathy of the Knee in Parkinson’s Disease with Pisa Syndrome: A Case of Knee-Spine Syndrome |
| title_short | Rapid Destructive Arthropathy of the Knee in Parkinson’s Disease with Pisa Syndrome: A Case of Knee-Spine Syndrome |
| title_sort | rapid destructive arthropathy of the knee in parkinson s disease with pisa syndrome a case of knee spine syndrome |
| url | http://dx.doi.org/10.1155/2021/6622445 |
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