Tibiofemoral Dislocation After Primary Total Knee Arthroplasty a Systematic Review
Abstract
Dislocation after full knee arthroplasty (TKA) is a rare complication, and few cases of anterior dislocation have been reported. Furthermore, at that place are no reports of early postoperative dislocation. A 72-year-quondam woman who had previously undergone resection of the posterior thigh muscle group for liposarcoma of the thigh underwent TKA for articulatio genus osteoarthritis. Notwithstanding, anterior dislocation was observed at i week postoperatively. We considered that the cause of the early anterior dislocation was previous resection of the posterior soft tissues of the knee articulation. This case is a rare study of early inductive postoperative dislocation after TKA.
Keywords
- Anterior human knee dislocation
- Total knee arthroplasty
- Total knee arthroplasty dislocation
Introduction
Dislocation after full knee arthroplasty (TKA) is a rare complication [
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Case history
The patient was a 72-twelvemonth-quondam woman who had been diagnosed with knee joint osteoarthritis 9 years before, and she visited our hospital considering of disease progression. She had a medical history of extensive tumor resection for liposarcoma of the thigh 31 years earlier at another infirmary. Part of the biceps femoris, semitendinosus, semimembranosus, adductor, and gastrocnemius muscles had been resected. In addition, the patient had undergone approximately 10 rounds of radiation therapy to compress the sarcoma before femoral liposarcoma resection. Upon presentation to our hospital, she was walking with a unmarried cane. Physical findings showed tenderness on the medial and lateral sides of the articulatio genus joint; no swelling or feeling of heat was observed, and the genu range of move (ROM) was fifteen°–90°. The quadriceps muscle strength was grade 4 on manual muscle testing. The anterior drawer examination was positive, the posterior drawer test was positive, and instability was observed in the varus and valgus stress tests. Surgical wounds from the tumor resection from the distal posterior thigh to the proximal posterior lower leg were observed (Fig. i). The wound had healed well, but a scar remained.
X-ray test showed disappearance of the articulation infinite, osteophyte hyperplasia, a bony defect in the proximomedial tibia, and severe knee osteoarthritis (Fig. 2). The oblique joint line bending in the valgus and varus stress radiograph was 5° and 7°, respectively. Varus and valgus stress radiographs showed instability of the articulatio genus articulation. Radiographic lower limb alignment showed a femorotibial bending of 204° and a mechanical axis of −73% (Fig. 3).
Figure 3 Preoperative radiograph. (a) Valgus stress view. (b) Varus stress view. (c) Radiographic whole lower limb alignment. The femorotibial angle is 204°, and the mechanical axis is −73%. The mechanical axis represents the signal at which the Mikulicz line (the line connecting the center of the femoral head to the center of the talus) passes from the most medial side of the tibial plateau.
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The Knee Injury and Osteoarthritis Outcome Score breakdown was every bit follows: total, 44 points; symptoms, 39%; pain, 47%; role/daily living, 63%; sport/recreation, 10%; and quality of life, 0%. The Human knee Order Score was 42/100, and the Function Score (Knee Society Score) was 55/100.
We performed TKA (Persona, CPS; Zimmer Biomet, Warsaw, IN) with the medial parapatellar approach and with the measured resection technique. The patient had severe osteoarthritis of the knee; therefore, we prepared a constrained implant as a backup. No medial-lateral instability of the human knee joint was observed during the operation. In add-on, we used CPS-blazon implants because we confirmed that there was no inductive instability at 0° and xc° of human knee joint flexion. Postoperative radiographs showed no abnormalities (Fig. 4). The patient began ROM preparation the day after surgery, with no weight-bearing for 1 week after surgery. One week after surgery, the patient developed discomfort in the knee articulation during ROM preparation, and radiographs showed inductive dislocation of the tibia (Fig. 5). No pain and no neurovascular symptoms in the lower leg were observed. Computed tomography showed anterior tibial dislocation, as with radiographs. The rotational femoral component angle (RFA) was ii.seven°, the rotational tibial component bending (RTA) was 2.4°, and the implant placement was normal (Fig. 6). Magnetic resonance imaging showed continuity of the patellar tendon and maintenance of the articulatio genus extensor mechanism (Fig. 7).
Figure 6 Computed tomography on the day of dislocation. (a) Axial view of the femoral component. A, Surgical epicondylar axis. B, Posterior condylar line. The rotational femoral component angle is the angle betwixt A and B, which is 2.7° in this patient. (b) Centric view of the tibial component. A, A line connecting the heart of the tibial component and the medial tertiary of the tibial tubercle. B, A line perpendicular to the posterior condylar line of the tibial component. C, Posterior condylar line. The rotational tibial component angle is the angle between A and B, which is 2.4° in this patient.
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On the same day that anterior dislocation was observed, nosotros manually reduced the articulatio genus joint. The dislocation was reduced by a posterior translocation force applied to the proximal tibia in approximately 10° of flexion. No neurovascular symptoms in the lower leg were observed later reduction. However, the 24-hour interval after reduction, radiographs showed redislocation. No neurovascular symptoms in the lower leg were observed after redislocation. We determined that conservative treatment such as long leg casting would not be successful, and 7 days later, we performed TKA revision (NexGen, RHK; Zimmer Biomet, Warsaw, IN). Intraoperative findings showed that the tibia was confused and that reduction was possible in a slight flexion position. At that place was no instability at 90° of flexion, and the tibia was dislocated when the tibia was pulled anteriorly with the knee in approximately 10° of flexion. There was no loosening of the implant. The surgery was performed with the medial parapatellar approach, and we changed the femoral and tibial implants to stemmed implants and hinge-type inserts. The revision surgery restored knee articulation stability. Because of the 2 major surgeries in a short menstruation of fourth dimension, the knee was immobilized in the extended position for 1 week to allow the articulatio genus to rest. The patient was immune to brainstorm ROM training at 2 weeks and full-weight-bearing exercise at 4 weeks postoperatively.
One yr after the performance, radiographs showed no redislocation and no implant loosening. Radiographic lower limb alignment showed a femorotibial angle of 170° and a mechanical centrality of 60% (Fig. 8). There was no pain in the knee joint, and the ROM was 0°–90°. The Articulatio genus Injury and Osteoarthritis Outcome Score breakdown was as follows: total, 71 points; symptoms, 93%; pain, 97%; role/daily living, 75%; sport/recreation, 5%; and quality of life, 37.five%. The Genu Gild Score was 93/100, and the Part Score (Knee Society Score) was lxx/100.
Discussion
2Dislocation after TKA is a rare complication, and few cases have been reported. In 1979, Insall et al. [
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Mizu-uchi et al. [
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A high incidence of related neurovascular complications can exist observed in cases of inductive dislocation after TKA [
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In our case, there were no neurovascular symptoms later on reduction. We attempted conservative treatment with extension-positioned casting, but this treatment was unsuccessful. During the reoperation, we changed to stemmed implants and hinged components. In our case, the main cause of the anterior dislocation was instability in mid-flexion secondary to resection of the posterior femoral muscle group. When the articulatio genus flexor muscles such as the hamstrings, semimembranosus muscle, sartorius musculus, gracilis muscle, popliteus musculus, and gastrocnemius musculus are non operation because of tumor resection, as in our case, there is a possibility of anterior dislocation in mid-flexion. It is difficult to predict anterior dislocation in advance, and using constrained implants should be considered when such cases are diagnosed.
Summary
Inductive dislocation afterwards TKA is a rare complication. Early reduction and assessment of complications of neurovascular injury are necessary. Knee flexor dysfunction tin can cause anterior dislocation. Therefore, when dysfunction of the articulatio genus flexor muscles is present, such as that caused by large resection of the posterior thigh musculature, nosotros should consider using higher level constrained-blazon implants.
Conflicts of interest
The authors declare that they have no known competing financial interests or personal relationships that could take appeared to influence the work reported in this article.
Informed patient consent
The authors confirm that written informed consent has been obtained from the involved patient or if advisable from the parent, guardian, power of attorney of the involved patient, and they have given approval for this information to exist published in this case report.
Acknowledgment
The authors thank Jane Charbonneau, DVM, from Edanz Group (https://jp.edanz.com/ac) for editing a draft of this manuscript.
Appendix A. Supplementary data
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Article Info
Publication History
Published online: Jan 17, 2022
Accepted: Nov 28, 2021
Received in revised form: November 20, 2021
Received: Baronial 9, 2021
Identification
DOI: https://doi.org/10.1016/j.artd.2021.xi.015
Copyright
© 2021 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee joint Surgeons.
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