Napp M, Frank M, Wittig O, Witt M
Abteilung für Orthopädische, Unfall- und Handchirurgie, Klinikum Plau am See, Plau am See.
Orthopade. 2010 Sep;39(9):879-82. doi: 10.1007/s00132-010-1629-x.
Unicompartmental knee arthroplasty can be viewed as a procedure with reliable medium- to long-term success. However, complications occur. To the authors' knowledge, this is the first report on an open dislocation of the tibial component (polyethylene plate) of a mobile bearing unicondylar knee prosthesis. Twelve days after a unicompartmental knee arthroplasty a 69-year-old patient suffered an open knee trauma due to a simple fall on the ground. The clinical examination showed wound dehiscence of the former mid-line approach, ventral dislocation of the polyethylene plate and a rupture of the anterior cruciate ligament. A pragmatic surgical treatment consisting of a jet lavage with saline solution, disinfection and relocation of the polyethylene plate and application of prophylactic antibiotics was performed. No peri- or postoperative complications were observed. The 6-month follow-up revealed a range of motion of 0-0-120° for extension-flexion and an isolated anterior instability. The patient was satisfied. This case report adds an uncommon and previously unpublished complication associated with unicompartmental knee arthroplasty. Surgical management in revision knee arthroplasty is challenging, although pragmatic approaches might be successful. Open dislocation of the bearing in a unicondylar knee prosthesis demands immediate revision. The manner of treatment depends on clinical findings and the surgeon's experience with arthroplasty.
单髁膝关节置换术可被视为一种具有可靠中长期成功率的手术。然而，并发症仍会发生。据作者所知，这是关于活动平台单髁膝关节假体胫骨部件（聚乙烯板）开放性脱位的首例报告。一名69岁患者在单髁膝关节置换术后12天，因简单地摔倒在地而遭受开放性膝关节创伤。临床检查显示原中线入路伤口裂开、聚乙烯板向前脱位以及前交叉韧带断裂。实施了包括用生理盐水喷射冲洗、消毒、聚乙烯板复位以及应用预防性抗生素在内的务实手术治疗。未观察到围手术期或术后并发症。6个月随访显示屈伸活动范围为0 - 0 - 120°，且存在单纯前向不稳定。患者感到满意。本病例报告增加了一种与单髁膝关节置换术相关的罕见且此前未发表的并发症。翻修膝关节置换术的手术处理具有挑战性，尽管务实的方法可能会成功。单髁膝关节假体的承重部件开放性脱位需要立即翻修。治疗方式取决于临床发现以及外科医生的关节置换经验。
