Lateral dislocation of the knee joint after total knee arthroplasty: a case report
© Ugutmen et al; licensee BioMed Central Ltd. 2008
Received: 18 July 2008
Accepted: 08 August 2008
Published: 08 August 2008
Total knee arthroplasty (TKA) is a successful therapy for functional improvement and pain relief in advanced symptomatic degeneration of the knee joint. But it can be associated with many complications, one of which is instability.
A 70-year-old woman was referred to our hospital because of right knee dislocation after TKA was performed on her right knee due to severe varus deformity and flexion contracture. This instability was caused by persistent MCL tightness and iatrogenic lateral collateral, arcuate ligament, and popliteus tendon injury.
The torn lateral collateral ligament and arcuate ligament were sutured with no. 2 non-absorbable (Ethibond) sutures with plication of the posterolateral knee capsule. A deep-dish liner was inserted to optimize soft tissue tension.
This is a very severe complication, and surgeons must be cautious about ligament balancing and soft tissue resection during TKA for severe varus and valgus deformities.
Total knee arthroplasty (TKA) is a successful therapy for functional improvement and pain relief in advanced symptomatic degeneration of the knee joint . But it can be associated with many complications, one of which is instability .
We describe a case of postoperative lateral knee dislocation after TKA. To our knowledge, there have been case reports in the English literature about anterior and posterior knee dislocation after TKA but not about lateral dislocation .
In this report, we aimed to investigate the reason for this type of complication, describe the required treatment modality, and emphasize the importance of ligamentous balancing during TKA.
This was a case of asymmetric extension instability due to preoperative severe varus angular deformity of the knee; this instability was caused by persistent MCL tightness and iatrogenic lateral collateral, arcuate ligament, and popliteus tendon injury . Although anterior and posterior dislocation after TKA has been reported, we have not found any case reports regarding acute lateral dislocation after TKA in the English literature; we did however find some report of post-TKA lateral subluxation [3, 7]. The dislocated knee was first tried to be reduced under general anesthesia in order to prevent vascular or neurological insult. Reducing the knee would also give us the opportunity to make a surgery in a normally aligned knee which would probably decrease the possibility of the iatrogenic nerve or vascular injury.
In our case, instead of using a constrained implant, keeping in mind that asymmetric extension instability occurs due to insufficient medial release after TKA in a knee with preoperative varus deformity, we attempted to achieve satisfactory soft tissue balance with adequate medial release and by using a thicker tibial insert. Further, since iatrogenic acute grade III injury of the posterolateral corner was present, we preferred direct anatomic repair of the injured structures . Nevertheless, the usual technique for dislocation of knee joint after knee arthroplasty is a constrained implant and isolated ligament reconstructions and polyethylene insert exchanges can fail to restore stability to the knee . Also, constrained prosthesis would have allowed early range of motion and immediate full weight bearing in our patient.
One disastrous complication of a recurrent dislocation of total knee arthroplasty is also a vascular complication even can result in an above-knee amputation , so surgeons must be extremely cautious about ligament balancing and soft tissue resection during TKA for severe varus and valgus deformities [7, 9, 10].
This complication occured due to the inadequate release of tight MCL with iatrogenic lateral collateral, arcuate ligament, and popliteus tendon injury during total knee arthroplasty to a knee with severe varus angular deformity. 14 months postoperatively, our patient is well with independent walking but longer follow up of is necessary to completely assess the success of our treatment.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Total knee arthroplasty
Medial collateral ligament
methicillin-resistant Staphylococcus aureus
Range of motion.
No funding has been received for the study.
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