title: Tibiofemoral Dislocation After Total Knee Arthroplasty.
abstract: Tibiofemoral dislocation after total knee arthroplasty (TKA) is a rare complication. Published case reports describe fewer than 6 patients, making conclusions about the etiology, epidemiology, complications, and treatment of tibiofemoral dislocation difficult. This case series highlights common demographic features, potential causes, and difficulties during the management of tibiofemoral dislocations after TKA.
  
  
  
  Between 2005 and 2014, 14 patients presented to our institution with a tibiofemoral dislocation. Patients were excluded if they had patellofemoral dislocation or subluxation without a tibiofemoral dislocation. We retrospectively reviewed patient demographics, time to first dislocation, number of dislocations, time to surgical intervention, complications, and potential etiologies of tibiofemoral dislocation.
  
  
  
  Twelve of 14 patients were female. Their mean body mass index was 33 ± 10 kg/m(2). Thirteen of 14 patients had a mean of 2.0 ± 1.4 dislocations. Four patients dislocated due to polyethylene damage and 5 due to ligamentous incompetence. Twelve of 14 patients required open surgical intervention. Complications in this patient population were common with 3 cases of infection, 7 cases of multiple dislocation, 2 cases of popliteal artery laceration, 1 case receiving a fusion, and 1 case receiving an amputation.
  
  
  
  Patients with tibiofemoral dislocation after TKA are predominantly obese, female, and have a high risk for complications. They dislocate predominantly because of polyethylene damage or ligamentous incompetence. Re-dislocation is common if treated with closed reduction alone.
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California.
authors.forename: Rishabh G
authors.initials: RG
authors.lastname: Jethanandani
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California.
authors.forename: William J
authors.initials: WJ
authors.lastname: Maloney
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California.
authors.forename: James I
authors.initials: JI
authors.lastname: Huddleston
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Goodman
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California.
authors.forename: Derek F
authors.initials: DF
authors.lastname: Amanatullah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D004204:Joint Dislocations; D031221:Knee Dislocation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D020959:Polyethylene; D011150:Popliteal Artery / Q000293:injuries; D012189:Retrospective Studies
chemical_list: D020959:Polyethylene
keywords: complication; dislocation; revision; tibiofemoral; total knee arthroplasty