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An Unexpected Complication of Hip Arthroplasty: Knee Dislocation.

Yilmaz S, Cankaya D, Deveci A, Ozdemir M, Bozkurt M - Case Rep Orthop (2015)

Bottom Line: An increasing number of patients with hip fracture have been seen with osteoporosis associated with osteoarthritis.Partial arthroplasty was planned because of osteoporosis.In conclusion, it should be emphasized that overtraction must be avoided during the hip reduction maneuver in patients with advanced osteoarthritic knee.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, 06100 Ankara, Turkey.

ABSTRACT
An increasing number of patients with hip fracture have been seen with osteoporosis associated with osteoarthritis. Although knee dislocation is related to high-energy trauma, low-grade injuries can also lead to knee dislocation which is defined as "ultra-low velocity dislocation." The case reported here is of an 82-year-old patient who presented with a left intertrochanteric hip fracture. Partial arthroplasty was planned because of osteoporosis. In the course of surgery, degenerative arthritic knee was dislocated during the hip reduction maneuver with the application of long traction. The neurovascular examination was intact, but the knee was grossly unstable and was dislocated even in a brace; thus a hinged knee prosthesis was applied nine days after surgery. The patient was mobilized with crutches after the knee prosthesis but exercise tolerance was diminished. In conclusion, it should be emphasized that overtraction must be avoided during the hip reduction maneuver in patients with advanced osteoarthritic knee.

No MeSH data available.


Related in: MedlinePlus

Degenerative arthritis and torn cruciate ligaments were seen and a rotating hinged knee prosthesis was applied.
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fig5: Degenerative arthritis and torn cruciate ligaments were seen and a rotating hinged knee prosthesis was applied.

Mentions: An 82-year-old female patient complaining of left hip pain after a simple fall was admitted to our hospital. There was pain and tenderness in the left groin and the patient could not stand on the left leg. The patient was mobilized with a cane before the trauma and body mass index was 23.8. The radiography revealed an intertrochanteric hip fracture (Figure 1) and the patient was hospitalized. After preoperative preparations, it was decided to perform hip arthroplasty instead of fixation because of severe osteoporosis and the low adaptive cooperation of this low-demand patient. Bipolar hip arthroplasty was applied with a posterolateral incision under spinal anesthesia. A cemented prosthesis was applied because of insufficient stability during the operation. After the femoral stem and the bipolar head were placed, an assistant applied traction to reduce the hip. The reduction was difficult to achieve and required aggressive reduction maneuvers. Hip radiography taken in the operating room was satisfactory and the femoral stem was not high placed (Figure 2). During the operation both legs were draped with elastic bandages and the knee was overlooked. After the operation when the patient was transferred to the bed, the left knee was seen to be deformed (Figure 3). Knee dislocation with underlying knee osteoarthritis was detected on radiography (Figure 4). The neurovascular evaluation was intact and the vascular continuity was confirmed with Doppler ultrasonography. However, the knee was grossly unstable so that it dislocated even in the cast or a knee brace. Treatment with a rotating hinged knee prosthesis was planned for the dislocated knee to be able to mobilize the patient as soon as possible. Surgery was applied 9 days after the first operation (Figure 5). A hinged knee prosthesis was applied and no complications were seen postoperatively (Figure 6). After the operation the patient was encouraged to comply with knee and hip strengthening and range of motion exercises. The patient was mobilized with a walker. It was subsequently learned from the family that the patient died due to cardiac arrest 7 months postoperatively.


An Unexpected Complication of Hip Arthroplasty: Knee Dislocation.

Yilmaz S, Cankaya D, Deveci A, Ozdemir M, Bozkurt M - Case Rep Orthop (2015)

Degenerative arthritis and torn cruciate ligaments were seen and a rotating hinged knee prosthesis was applied.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4546968&req=5

fig5: Degenerative arthritis and torn cruciate ligaments were seen and a rotating hinged knee prosthesis was applied.
Mentions: An 82-year-old female patient complaining of left hip pain after a simple fall was admitted to our hospital. There was pain and tenderness in the left groin and the patient could not stand on the left leg. The patient was mobilized with a cane before the trauma and body mass index was 23.8. The radiography revealed an intertrochanteric hip fracture (Figure 1) and the patient was hospitalized. After preoperative preparations, it was decided to perform hip arthroplasty instead of fixation because of severe osteoporosis and the low adaptive cooperation of this low-demand patient. Bipolar hip arthroplasty was applied with a posterolateral incision under spinal anesthesia. A cemented prosthesis was applied because of insufficient stability during the operation. After the femoral stem and the bipolar head were placed, an assistant applied traction to reduce the hip. The reduction was difficult to achieve and required aggressive reduction maneuvers. Hip radiography taken in the operating room was satisfactory and the femoral stem was not high placed (Figure 2). During the operation both legs were draped with elastic bandages and the knee was overlooked. After the operation when the patient was transferred to the bed, the left knee was seen to be deformed (Figure 3). Knee dislocation with underlying knee osteoarthritis was detected on radiography (Figure 4). The neurovascular evaluation was intact and the vascular continuity was confirmed with Doppler ultrasonography. However, the knee was grossly unstable so that it dislocated even in the cast or a knee brace. Treatment with a rotating hinged knee prosthesis was planned for the dislocated knee to be able to mobilize the patient as soon as possible. Surgery was applied 9 days after the first operation (Figure 5). A hinged knee prosthesis was applied and no complications were seen postoperatively (Figure 6). After the operation the patient was encouraged to comply with knee and hip strengthening and range of motion exercises. The patient was mobilized with a walker. It was subsequently learned from the family that the patient died due to cardiac arrest 7 months postoperatively.

Bottom Line: An increasing number of patients with hip fracture have been seen with osteoporosis associated with osteoarthritis.Partial arthroplasty was planned because of osteoporosis.In conclusion, it should be emphasized that overtraction must be avoided during the hip reduction maneuver in patients with advanced osteoarthritic knee.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, 06100 Ankara, Turkey.

ABSTRACT
An increasing number of patients with hip fracture have been seen with osteoporosis associated with osteoarthritis. Although knee dislocation is related to high-energy trauma, low-grade injuries can also lead to knee dislocation which is defined as "ultra-low velocity dislocation." The case reported here is of an 82-year-old patient who presented with a left intertrochanteric hip fracture. Partial arthroplasty was planned because of osteoporosis. In the course of surgery, degenerative arthritic knee was dislocated during the hip reduction maneuver with the application of long traction. The neurovascular examination was intact, but the knee was grossly unstable and was dislocated even in a brace; thus a hinged knee prosthesis was applied nine days after surgery. The patient was mobilized with crutches after the knee prosthesis but exercise tolerance was diminished. In conclusion, it should be emphasized that overtraction must be avoided during the hip reduction maneuver in patients with advanced osteoarthritic knee.

No MeSH data available.


Related in: MedlinePlus