Gungor Harun Resit, Kiter Esat, Akkaya Semih, Ok Nusret, Yorukoglu Cagdas
Orthopedics and Traumatology Department, Pamukkale University Medical Faculty, Pamukkale, 20070 Denizli, Turkey.
Case Rep Orthop. 2015;2015:716148. doi: 10.1155/2015/716148. Epub 2015 Jun 22.
Following total knee arthroplasty (TKA), the most frequent cause of extension deficit and limitation of range of motion in early postoperative period is related to improper tensioning of soft tissues and failure to balance extension and flexion gaps. If a cruciate retaining (CR) prosthesis is the planned implant, then attention should be given to balancing the posterior cruciate ligament (PCL), and any factor that alters this balance may also cause deterioration of knee balance in postoperative period. Here, we report on an unusual case referred from another hospital because of continuous pain and restriction of knee motion in early postoperative period following CR-designed TKA that was initially thought to be due to flexion-extension imbalance. However, during the revision procedure, extruded cement to the intercondylar notch was found to be both mechanically blocking terminal extension and limiting flexion by possible mechanism of irritation of the synovial nerve endings around the stretched anterior fibers of PCL during flexion. This case was successfully treated by removal of extruded cement from intercondylar notch to decompress PCL, polyethylene exchange, and secondary patellar resurfacing.
全膝关节置换术（TKA）后，术后早期伸展受限和活动范围受限的最常见原因与软组织张力不当以及未能平衡伸展和屈曲间隙有关。如果计划植入保留交叉韧带（CR）的假体，那么应注意平衡后交叉韧带（PCL），任何改变这种平衡的因素也可能导致术后膝关节平衡恶化。在此，我们报告一例不寻常的病例，该病例来自另一家医院，原因是在采用CR设计的TKA术后早期持续疼痛和膝关节活动受限，最初认为这是由于屈伸不平衡所致。然而，在翻修手术中，发现髁间切迹有挤出的骨水泥，它在机械上阻碍了终末伸展，并且在屈曲时通过拉伸PCL前纤维周围的滑膜神经末梢可能引起刺激的机制限制了屈曲。通过从髁间切迹清除挤出的骨水泥以减压PCL、进行聚乙烯置换和二次髌骨表面置换，该病例得到了成功治疗。
