An Unexpected Complication of Hip Arthroplasty: Knee Dislocation |

Recent research including that appearing in the British Medical Journal, found that 7 to 23% of patients who had hip replacement continued to have long term unresolved pain.

In studying both hip and knee replacements, they concluded: “The proportion of people with an unfavorable long-term pain outcome in studies ranged from about 7% to 23% after hip and 10% to 34% after knee replacemet. . . After hip and knee replacement, a significant proportion of people have painful joints. There is an urgent need to improve general awareness of this possibility and to address determinants of good and bad outcomes.”1

In another study, doctors warned each other that they must make the patients aware of complications that could include “fracture, neurovascular damage, leg length discrepancy, (surgery) failure, premature loosening, death, medical complications, ongoing pain, stiffness, wound healing problems.” 2

In new research, doctors are reporting that 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.”

In a case study doctors saw an 82-year-old patient with left 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.3

Please see this article for a more detailed discussion on Hip Replacement Alternatives

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1. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012 Feb 22;2(1):e000435.Print 2012.

2. Isherwood J, Dean B, Pandit H. Documenting informed consent in elective hip replacement surgery: a simple change in practice. Br J Hosp Med (Lond). 2013 Apr;74(4):224-7.

3. Yilmaz S, Cankaya D, Deveci A, Ozdemir M, Bozkurt M. An Unexpected Complication of Hip Arthroplasty: Knee Dislocation. Case Rep Orthop. 2015;2015:294187. doi: 10.1155/2015/294187. Epub 2015 Aug 10.