I lost the quadriceps muscles in my right knee years ago in an explosion. I have no extension capability. However, I have full use of hamstring and am also able to press knees together. Three years ago I had a TKA on left leg dut to severe arthritis. Now the right knee needs the same treatment but my surgeon is of the opinion that a TKA without the quadriceps muscles would be unstable. Surgery would also be complicated by a depressed patella (down below normal position), and some adhesion of old patella/quadriceps ligaments. Flexion is about 120 degrees. Extension is a bit beyond normal.

I would appreciate your opinion(s). The only studies we have been able to find are related to TKA patients who had had polio... and had some paralysis. That report asserted that those with inablity to extend the knee against gravity, experienced pain. No mention was made of 'instability.

My doctor (surgeon)'s name, address, phone available on request.

Clayton Benner 1055 Evenstar Avenue Westlake Village, CA 91361-2070 805-496-5979

-- Clayton J. Benner (kleightonB@aol.com), August 05, 2001

Answers

A normal joint has to have fundamental characteristics. It must be stable, [stability is provided by both muscles and ligaments]. The joint must move in the proper direction for that specific joint [movement is either passive or active] and it must be comfortable.

A knee without a quadricep will not have active extension and will not be stable when weight is applied. It will collapse into flexion. A total knee will not restore dynamic stability or active extension, but it could restore comfort and the stability issue could be addressed with the use of a brace.

-- David S. Hungerford, M.D. (dhunger@jhmi.edu), August 24, 2001.

Thank you very much.... your message is very encouraging. Following up, if you are interested:

I have managed to get an appointment for a consultation with a former UCLA Med School (Professor) teacher. His name is Dr. John Moreland. He was associated, at UCLA, with Dr. Dennis Sakai (retired), the surgeon who did my left knee TKA. Also, he was teaching when my current surgeon, Dwite Dahms, was a resident/student at UCLA.

Dahms expressed much the same opinion as you did. That is, a TKA will solve my arthritis pain problem, but of course, I will still have to stand with it in full extention (locked) position; which I have been doing since loosing the Quads in 1947 when I was 17years old.

Thank you so much for your reply.... The encouragement is almost lifegiving. If you would like me to advise you later on how things work out... maybe for your clinical records... please let me know.

Clayton

-- Clayton Benner (kleightonb@aol.com), August 24, 2001.