title: Multi-ligament instability after early dislocation of a primary total knee replacement - case report.
abstract: Peripheral nerve blocks have found increased popularity in providing prolonged post-operative analgesia following total knee replacement surgery. They generally provide effective analgesia with fewer complications than epidurals. This report describes an acute low-energy knee dislocation after a well balanced, fixed bearing, cruciate-retaining primary total knee replacement performed under a spinal anaesthetic with combined complimentary femoral and sciatic nerve blocks. The dislocation was not accompanied by neurovascular compromise. Due to the subsequent instability and injury to both collaterals, the posterior cruciate ligament and posterolateral corner structures, the knee was treated with a rotating-hinge revision total knee replacement. The dislocation occurred whilst the peripheral nerve blocks (PNB) were still working. We review our incidence of PNB related complications and conclude that PNB remain a safe and effective analgesia for total knee replacements. However, we advocate that ward staff and patients should be sufficiently educated to ensure that unaided post-operative mobilisation is prevented until such a time that patients have regained complete voluntary muscle control.
authors.affiliation: The Royal Bournemouth Hospital, United Kingdom. sisakkrisztian@hotmail.com
authors.forename: Krisztian
authors.initials: K
authors.lastname: Sisak
authors.forename: John
authors.initials: J
authors.lastname: Lloyd
authors.forename: Nick
authors.initials: N
authors.lastname: Fiddian
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000775:Anesthesia, Spinal / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002358:Cartilage, Articular / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000473:pathology*; D031221:Knee Dislocation / Q000473:pathology* / Q000601:surgery; D007719:Knee Joint / Q000473:pathology* / Q000601:surgery; D009407:Nerve Block / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology*; D012086:Reoperation