Anterior dislocation after
total knee arthroplasty (TKA) is rare; 9 cases have been reported in the English literature. Five patients sustained subluxation, with recurvatum as the clinical manifestation, and 4 patients sustained complete dislocation, usually accompanying other serious complications.This article describes a case of complete dislocation that developed atraumatically 16 years after TKA and was characterized by dislocation in extension and spontaneous reduction in flexion. Revision TKA was planned, with several alternative procedures under consideration, ranging in degree of invasiveness from simple
polyethylene exchange to conversion to a hinge-typed
prosthesis. Intraoperatively, extensive areas of blackened synovium and posterior-dominant
polyethylene wear existed medially and laterally. Considering the patient's age of 82 years, low activity level in
activities of daily living, edematous skin, and number of stable components, we performed simple
polyethylene exchange to a cruciate-retaining component that left the partial
metal defect in the tibial plate untouched. Successful outcome was achieved for >2 years. The dislocation mechanism was
polyethylene thinning, leading to relative valgus and anteroposterior instability that aggravated the anterior cruciate ligament dysfunction, which is speculated as the inherent key causative factor in every TKA.Complete dislocation, usually accompanying other complications, requires prompt treatment because the possibility of serious consequences exists. Due to the absence of a gold standard, the treatment of choice needs to be made on a case-by-case basis.