Posterior dislocation of a cruciate-retaining total knee arthroplasty following an acute bacterial infection

Chu, Cheng-Mien; Wang, Shyu-Jye; Wu, Shing‐Sheng

doi:10.1007/s00402-003-0489-9

Cited by 7 publications

(10 citation statements)

References 13 publications

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“… 7 Hence, regarding these issues Bonnaig et al 8 hypothesized that the soft tissues including the cruciate and collateral ligaments were made incompetent by enzymes from both the pathogenic organism and from the host immune cells and subsequent stretching with mobilization allowed the knee to dislocate without a direct traumatic event. The similar attribution was made by Chu et al 9 in a posterior dislocation of a cruciate-retaining total knee arthroplasty (TKA) following an acute bacterial infection. The patient's premature weight-bearing activity on her acute septic knee and the injury forces acting on a semi-flexion position of the knee were responsible for the ultimate tearing of the fragile posterior cruciate ligament(PCL).…”

Section: Discussionsupporting

confidence: 60%

Total joint replacement for neglected posterior knee dislocation following septic arthritis after arthroscopy

Öztürkmen¹,

Akman²,

Ünkar³

et al. 2017

Acta Orthopaedica et Traumatologica Turcica

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This report presents the first case of a knee dislocation following septic arthritis after arthroscopy. A 65-year-old woman had an arthroscopy with irrigation and debridement (I&D) of the joint and microfracture for the chondral lesions. She had complaints of postarthroscopic infection but non-steroidal anti-inflammatory medication and local ice compression was recommended. She revisited her physician twice and at the last visit she had a large purulent effusion in her knee. The gram stain of the joint fluid aspirate demonstrated gram-positive cocci and the cultures grew methicilline-sensitive Staphylococcus aureus. She underwent arthroscopic assisted I&D and received intravenous antibiotics. I&D was repeated after two weeks. Intravenous antibiotherapy was continued for one more week and was changed to oral antibiotherapy for six weeks. At the third month visit's physical examination, a deformity at the knee was noticed and was referred to us for further treatment. A posterior knee dislocation with no neurovascular deficit was detected. The patient had a history of knee sprain but did not seek medical advice immediately. The blood samples showed no abnormality. The patient underwent a surgery with a cemented hinged revision total knee prosthesis following the exclusion of the active knee joint infection. Intraoperative frozen sections were also taken to exclude the active infection. The patient's knee is pain-free with full range of motion after 3 years. The objective of this report was to highlight the importance of early diagnosis, prompt appropriate treatment of septic arthritis following arthroscopy and the awareness of the knee dislocation as a rare dreadful complication of postarthroscopic infection particularly in elderly patients.

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Section: Discussionsupporting

confidence: 60%

Total joint replacement for neglected posterior knee dislocation following septic arthritis after arthroscopy

Öztürkmen¹,

Akman²,

Ünkar³

et al. 2017

Acta Orthopaedica et Traumatologica Turcica

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“…In the current case, the mechanism that caused posterior dislocation of TKA and tibia fracture was the posteriorly directed force during flexion causing dislocation of patella with ruptured arthrotomy healing site and tear of PCL leading to subsequent posterior translation of tibia and twisting thereafter producing shear force fracturing the tibia and fibula at the same time. Similarly, Chu et al, 14 presented a case with a posterior dislocation of a cruciateretaining TKA following an acute bacterial infection. They mentioned that their case had been exposed to a minor sprain giving rise to patellar subluxation.…”

Section: Discussionmentioning

confidence: 96%

“…The majority of cases reported to date are anterior subluxation, while only few cases of complete anterior dislocation have been described so far in literature. 2,6,11,[14][15][16] Wang and Wang 17 also defined these two instability patterns mentioning that posterior translation of the tibia occurring mainly in the postoperative period usually resulting from trauma and the other with anterior translation of tibia occurring 6 months to 7 years postoperatively with no preceding trauma, in the latter group instability was manifested gradually as a lengthening of the PCL and the posterior capsule, leading to a recurvatum deformity of the knee. In the current case, the mechanism that caused posterior dislocation of TKA and tibia fracture was the posteriorly directed force during flexion causing dislocation of patella with ruptured arthrotomy healing site and tear of PCL leading to subsequent posterior translation of tibia and twisting thereafter producing shear force fracturing the tibia and fibula at the same time.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous posterior dislocation of primary total knee arthroplasty with ipsilateral tibial shaft fracture: A case report and review of literature

Öztürk

Akalın

Çevik

et al. 2016

Journal of Clinical Orthopaedics and Trauma

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“…1 Although this surgery is often successful, it can be associated with a variety of complications, including infection, neurovascular injuries, stiffness, instability, and dislocation. 1,2 In the past decade, the incidence of significant instability and dislocation following primary TKA ranged from 1% to 2%. 1,2 However, with the advent of modern surgical techniques and posterior stabilized implants, this incidence has been lowered to 0.15% to 0.5%.…”

mentioning

confidence: 99%

“…1,2 In the past decade, the incidence of significant instability and dislocation following primary TKA ranged from 1% to 2%. 1,2 However, with the advent of modern surgical techniques and posterior stabilized implants, this incidence has been lowered to 0.15% to 0.5%. 3 Rates of more subtle instability after primary and revision TKA are more common, ranging from 10% to 20%.…”

mentioning

confidence: 99%

Revision Surgery for a Dislocated Constrained Total Knee Arthroplasty

Hagedorn¹,

Levine²

2012

Orthopedics

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Knee dislocation after revision total knee arthroplasty (TKA) is a dangerous, albeit rare, injury that can lead to neurovascular compromise and permanent disability. A paucity of peer-reviewed literature exists regarding this complication after revision TKA. Tibiofemoral dislocation commonly occurs with minimal trauma, such as rising from a seated position, and is commonly associated with a flexionextension gap mismatch. Prompt diagnosis and expedited treatment of this complication is necessary to minimize the risk of adjacent neurovascular structures. Acute management involves attempted reduction, knee stabilization, and thorough neurovascular workup. Long-term management may require revision surgery, with the level of articular constraint necessary being determined intraoperatively. This article describes 2 cases of relatively atraumatic knee dislocations after revision TKA involving the same semiconstrained components. Patient 1 was a 68-year-old man who sustained an atraumatic posterior knee dislocation 2 months after revision TKA. Patient 2 was a 55-year-old woman who presented after an atraumatic posterior knee dislocation 6 months after revision TKA. In both patients, a semiconstrained construct was used with corresponding revision components prior to dislocation. This article includes a synopsis of solutions for flexion-extension gap balancing and a review of the literature regarding this uncommon complication.

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Posterior dislocation of a cruciate-retaining total knee arthroplasty following an acute bacterial infection

Abstract: Soft-tissue protection from full weight-bearing of the knee during the treatment of an acute infection following total knee arthroplasty and timely removal of the loosened total knee prosthesis are recommended in order to prevent such a complication.

Cited by 7 publications

References 13 publications

Total joint replacement for neglected posterior knee dislocation following septic arthritis after arthroscopy

Total joint replacement for neglected posterior knee dislocation following septic arthritis after arthroscopy

Simultaneous posterior dislocation of primary total knee arthroplasty with ipsilateral tibial shaft fracture: A case report and review of literature

Revision Surgery for a Dislocated Constrained Total Knee Arthroplasty

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