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Total Knee Arthroplasty as the Primary Surgical Treatment After Knee Dislocation.

ABSTRACT: Traumatic knee dislocation (KD) is a rare but serious injury, and a missed diagnosis or incorrect treatment can be limb-threatening due to a significant risk of neurovascular injury. The mechanism of injury is often high-energy trauma, but there is a rising tendency of KD after low-energy trauma in the obese patient. KD often results in multiligament injury which can be a complicated surgical task with long recovery time, especially in older patients. This report presents 4 cases where patients older than 50 years with traumatic KD have been treated with a total knee arthroplasty of revision type as an alternative to multiligament reconstruction.

SUBMITTER: Gregersen MB

PROVIDER: S-EPMC9168382 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Total Knee Arthroplasty as the Primary Surgical Treatment After Knee Dislocation.

Gregersen Mathias Barslund MB Freund Knud Gade KG

Arthroplasty today 20220603

Traumatic knee dislocation (KD) is a rare but serious injury, and a missed diagnosis or incorrect treatment can be limb-threatening due to a significant risk of neurovascular injury. The mechanism of injury is often high-energy trauma, but there is a rising tendency of KD after low-energy trauma in the obese patient. KD often results in multiligament injury which can be a complicated surgical task with long recovery time, especially in older patients. This report presents 4 cases where patients ...[more]

PMID: 35677942

Similar Datasets

Traumatic anterior knee dislocation after total knee arthroplasty.

Project description:This article describes a traumatic complete anterior knee dislocation of a previously well-functioning total knee arthroplasty. A thorough physical examination with appropriate radiographic imaging study is required for proper evaluation and treatment of this injury, as it is often associated with neurovascular injury and subsequent global instability of the injured knee is likely.

| S-EPMC5045459 | biostudies-literature

Total knee arthroplasty for treatment of osteoarthritis with prolonged patellar dislocation.

Project description:Prolonged dislocation of the patella is a rare condition and is often related to severe osteoarthritis (OA) of the femorotibial (FT) joint. For this condition's treatment, numerous surgical techniques using total knee arthroplasty (TKA) have been published. To the best of our knowledge, this case report is the first description of the use of lateral release alone to treat recurrent patellar subluxation with TKA. An interesting point in this case is that the patient had a good recovery after TKA in spite of quite a long-term (a duration of almost 55 years) dislocation of her patella and development of secondary OA. We describe a case that we treated by TKA for FT-OA with a prolonged patellar dislocation. We were able to obtain good patellar reduction without additional surgery by performing adequate lateral release of the patellar retinaculum. This clinical case indicates the usefulness of lateral patellar retinaculum release for obtaining stable patellar tracking in TKA for FT-OA with remaining lateral patellar dislocation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

| S-EPMC5365408 | biostudies-literature

Posterior dislocation of a constrained total knee arthroplasty: A case report.

Project description:IntroductionDislocation of the knee after primary total knee arthroplasty is rare in a posterior stabilized knee and extremely rare in a constrained total knee arthroplasty. Constrained total knee prostheses are used for severe knee deformities and to provide stable and mobile knees.Presentation of caseIn this case, we describe a dislocation of a primary constrained total knee arthroplasty using the Genesis II (Smith & Nephew, Memphis Tennessee, USA) prosthesis. Without any significant trauma, the constrained insert dislocated fifteen months after surgery and revision surgery with a bigger insert was needed. Surgical error may have been the cause of dislocation, but we were unable to establish a clear reason behind this dislocation.DiscussionKnee dislocation after TKA is rare but easily overlooked and can lead to serious complications and permanent disability. This system should provide stable and mobile knees to correct collateral ligament laxity.ConclusionHere, we report the first case, to our knowledge, of dislocation with a constrained prosthesis without any history of trauma.

| S-EPMC6141696 | biostudies-literature

Expression data from total knee arthroplasty patients

Project description:Ischaemic preconditioning is a method of protecting tissue against ischaemia-reperfusion injury. It is an innate protective mechanism that increases a tissue's tolerance to prolonged ischaemia when it is first subjected to short burst of ischaemia and reperfusion. It is thought to provide this protection by increasing the tissue's tolerance to ischaemia, therby reducing oxidative stress, inflammation and apoptosis in the preconditioned tissue. We used microarrays to investigate the genomic response induced by ischaemic preconditioning in muscle biopsies taken from the operative leg of total knee arthroplasty patients in order to gain insight into the ischaemic preconditioning mechanism. Patients undergoing primary knee arthroplasty were randomised to control and treatment (ischaemic preconditioning) groups. Patients in the treatment group received a preconditioning stimulus immediately prior to surgery. The ischaemic preconditioning stimulus consisted of three five-minute periods of tourniquet insufflation on the lower operative limb, interrupted by five minute periods of reperfusion. All patients had a tourniquet applied to the lower limb after the administration of spinal anaesthesia, as per normal protocol for knee arthroplasty surgery. Muscle biopsies were taken from the quadriceps muscle of the operative knee at the immediate onset of surgery (T0) and at 1 hour into surgery (T1). Total RNA was extracted from biospies of four control and four treatment patients and hybridised to the Affymetrix Human U133 2.0 chip.

2010-04-12 | E-GEOD-21164 | biostudies-arrayexpress

Minimally invasive total knee arthroplasty: surgical implications for recovery.

Project description:Despite growing interest in minimally invasive surgery (MIS) techniques for total knee arthroplasty (TKA), few randomized controlled trials have compared MIS and conventional TKA using a combination of functional performance, knee pain, knee range of motion (ROM), and surgical and radiographic outcomes.A prospective, randomized investigation comparing early outcomes of TKA using conventional or MIS approaches (n = 44). Patients were assessed preoperatively, 48 hours, 4 and 12 weeks postoperatively by blinded evaluators. Outcome measures included timed-up-and-go, 100-ft walk, knee pain, passive knee ROM, Knee Society Score, blood loss, tourniquet time, hospital length of stay, surgical complications, and radiographic outcomes.No significant differences in functional performance, knee pain, knee ROM, surgical, or radiographic outcomes were observed between groups at 48 hours, 4 or 12 weeks postoperatively.While surgical and radiographic outcomes were not compromised with MIS surgery, there were also no improvements in pain, ROM, or functional performance with MIS TKA.

| S-EPMC4162390 | biostudies-literature

Rare Case of Traumatic Anterior Knee Dislocation of Total Knee Arthroplasty With a Serious Neurovascular Injury.

Project description:Traumatic anterior dislocation of a total knee arthroplasty (TKA) is an extremely rare occurrence. There are only a few known cases of this type of dislocation which discuss the high risk of a neurovascular complication. This article describes a traumatic anterior dislocation of the TKA with a severe vascular lesion in a 75-year-old severely comorbid patient. Further complications led to the development of a compartment syndrome. Despite the repeated effort in performing a well-functioning anastomosis of the popliteal artery tear by the vascular surgeon, reperfusion of the lower extremity was not effective. Furthermore, multiorgan system failure due to the reperfusion syndrome evolved. This led to an above-knee amputation as a lifesaving procedure. Despite thorough intensive care therapy, the patient did not survive this complication. Presently there are no reported cases with such severe complications after the luxation of a previously well-functioning TKA leading to the death of the patient.

| S-EPMC8361220 | biostudies-literature

Bacteriology swabs in primary total knee arthroplasty.

Project description:OBJECTIVE: An early detection of possible periprosthetic infection may lead to an earlier and potentially less invasive treatment of infected total knee arthroplasty TKA). The purpose of the present study was to evaluate retrospectively our current, affordable clinical practice of intra-operative swab taking during primary TKA. METHODS: A total of 206 primary TKA were analysed retrospectively for intra-operative bacteriology swabs and subsequent periprosthetic infection. All bacteriology swabs were obtained in a standardized manner including a tissue sample. Data was statistically evaluated concerning standard descriptive statistics and using the chi-square test. RESULTS: Bacteria were identified in 43.4% with coagulase-negative staphylococci being the most frequently isolated pathogens (52.2%). Regarding the contingency tables and chi-squared tests, generally no association was found between positive intra-operative swabs and subsequent periprosthetic infection as well as all other parameters investigated (timing of the antibiotic prophylaxis and pre-operative laboratory results). CONCLUSIONS: Bacteriology swabs during primary total knee arthroplasty are no adequate measure to predict subsequent periprosthetic infections, even if augmented with a tissue sample.

| S-EPMC3746596 | biostudies-other

Intra- operative fractures in primary Total Knee Arthroplasty.

Project description:BackgroundIntraoperative fracture during primary Total Knee Arthroplasty (TKA) is very rare and there is little literature available which has defined the possible reasons for the occurrence of these fractures. Further, no study till date has defined the various management options available to treat these fractures. This study aims to define (1) the possible reasons for different fracture patterns occurring intraoperatively, (2) the ideal management options for each type of fracture geometry, (3) whether this intraoperative complication affects the physiotherapy protocol and long term outcomes.MethodsOut of 3168 primary TKA done between 2010 and 2017, 19 patients developed intraoperative fracture, whose data was evaluated retrospectively. Patients were assessed radiologically to determine the time to union and clinical outcomes were assessed using Knee Society Score.ResultsOut of the 19 intraoperative fractures, 19 were in Tibia and 4 in Femur. Majority of fractures occurred during cementing and final implantation (8 cases), followed by exposure and bone preparation (6 cases) and the least during trialing (4 cases). Out of 15 Tibia fracture, 9 fractures involved the Tibial cortex which were managed with screws (4 cases), sutures and bone cement (5 cases). Stemmed tibial component was used for all Plateau type fracture patterns (6 cases). Out of 4 distal femur fractures, condylar type fracture pattern were fixed with plates and screws (3 cases) and epicondyle avulsion with screws alone (1 case). All the cases showed union (average union time 8.9 weeks) and good KSS scores which remained till their last follow-up. None of the patient developed any other complications or required revision surgery.ConclusionsIntraoperative fracture during TKA, although rare but a significant complication which can affect the outcome, if not managed properly. We have shown methods of management for such cases, which have given excellent results.

| S-EPMC6492217 | biostudies-literature

Expression data from total knee arthroplasty patients

2010-04-02 | GSE21164 | GEO

Surgical Technique of Total Knee Arthroplasty without Soft Tissue Balance.

Project description:Total knee arthroplasty (TKA) without soft tissue balance can create a balanced knee to a mechanical axis of near neutral with bone cuts, and remove osteophytes thoroughly. In this study, the authors present detailed steps for performing TKA. The attached video demonstrates the TKA procedure. The patient is a 77-year-old man who had suffered from knee pain for 12 years. Physical examination showed the Apley test to be positive and that the range of motion (ROM) decreased. An X-ray filmed at the positive lateral of the knee joint and the double lower extremity revealed a progression of degenerative osteoarthritis with genu varum. The key point of no soft tissue release is to make a rectangular extensional space by osteotomy. In addition, the osteophytes, especially syndesmophytes, should be removed thoroughly. As a result, the ligaments can achieve ideal length and the flexion contracture can also be remedied. Moreover, in surgeries without soft tissue release, bone mass and normal tissue are retained. Patients are satisfied to the surgery not only with less blood loss, anterior knee pain and DVT, but also faster rehabilitation. In summary, TKA without soft tissue balance is an efficient procedure for patients with knee osteoarthritis which can result in good prognosis.

| S-EPMC6584677 | biostudies-literature

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