Neglected Posterior Dislocation Septic Loosening and Prolonged Flexion Contracture of Total Knee Arthroplasty: A Case Report

Abstract

Patient: Male, 62-year-old Final Diagnosis: Arthroplasty • knee • posterior dislocation • prolonged flection contracture • septic loosening Symptoms: Knee joint pain Medication: — Clinical Procedure: — Specialty: Orthopedics and Traumatology Objective: Patient complains/malpractice Background: Chronic posterior knee dislocation after total knee arthroplasty (TKA) is a rare but serious complication, especially when it coexists with septic implant loosening, flexion contracture, and extensive comorbidities. Although the severity is comparable to that in the native knee dislocation, there are few reports in the literature. When TKA dislocation is complicated with infection, bone defect, and patient’s comorbidity, treatment becomes even more difficult. For these complex complications, in order to provide stable and mobile knees, constrained total knee prostheses are used. Case Report: We present the case of a 63-year-old, non-ambulatory man, with mental retardation and multiple comorbidities, who had a 9-year history of neglected posterior TKA dislocation, which later became complicated with septic loosening and productive fistula for 4 years. The patient required use of a wheel-chair for several years, was obese with a body mass index (BMI) of 34.3, and the affected knee was in a prolonged flexion contracture at 90°. The posterior TKA dislocation was later infected by Staphylococcus hominis and Staphylococcus epidermidis . He was successfully treated with two-stage revision surgery and managed to become ambulatory after 6 years of requiring use of a wheel-chair. Conclusions: Neglected posterior dislocation of TKA is a rare and potentially limp-causing complication, especially when accompanied with chronic infection, implant loosening, severe bone loss, flexion contracture, and extensive comorbidities. A multidisciplinary approach with careful preoperative planning, exceptional surgical technique, and prolonged supervised physiotherapy are the keystones for a successful outcome.

Use of Ilizarov technique for bilateral knees flexion contracture in Juvenile-onset ankylosing spondylitis: A case report

“…Septic knee arthritis can also result in KFC[ 15 ]. The Ilizarov technique is a viable option to achieve knee arthrodesis in cases of septic failure following TKA, post-traumatic knee infection, and end-stage tuberculosis of the knee[ 16 - 18 ].…”

Prosthetic Knee Joint Infection by Brucella melitensis

“…Once the implants were removed, a careful surgical debridement was performed, leaving significant bone defects, classified as F2-B/T1 according to the Anderson Orthopedic Research Institute (AORI) classification [5]. An antibiotic-loaded bone cement (ALBC) spacer, containing gentamicin and vancomycin, was placed and knee arthrodesis using a Steinman pin was utilized to provide stability (Figure 3) [6]. Intraoperative cultures were also obtained.…”