Global instability following primary total knee arthroplasty in patient with osteoarthritis and backache due to missed thoracic meningioma: our experience
Keywords:Total Knee arthroplasty, Meningioma, Osteoarthritis, Recurvatum instability
Recurvatum or hyperextension instability with bladder dysfunction and impeded walking after total knee arthroplasty due to a thoracic meningioma that was not detected on preliminary neurological evaluation (clinco-radiological) in an osteoarthritic patient with complaint of backache, muscle weakness and claudication. Magnetic resonance imaging (MRI) whole spine revealed a thoracic mass at the level D2-3. Complete resection of spinal mass was done. The knee was revised with rotating hinge prosthesis following spinal surgery. The diagnosis requires an algorithmic approach to identify the cause and best available management options. It is strongly suggested that thorough neurological examination of whole spine should be done preoperatively if lumbar imaging is unconvincing or is incompatible with the history and clinical examination to prevent such serious complications.
Parratte S, Pagnano MW. Instability after total knee arthroplasty. J Bone Joint Surg Am. 2008;90(1):184-94.
Vince KG, Abdeen A, Sugimori T. The unstable total knee arthroplasty: causes and cures. J Arthroplasty. 2006;21(4):44-9.
Wong YC, Cheong PM, Wai YL. Recurvatum Instability after total knee arthroplasty-case report and literature review. Hong Kong Journal of Orthopaedics Surgery. 2003;7(1):46-9.
Meding JB, Keating EM, Ritter MA, Faris PM, Berend ME. Genu recurvatum in total knee replacement. Clin Orthop Relat Res. 2003;(416):64-7.
Gunston FH, MacKenzie RI. Complications of polycentric knee arthroplasty. Clin Orthop.1976;120:11-2.
Eggers KA, Asai T. Postoperative brachial plexus neu-ropathy after total knee replacement under spinalanaesthesia. Br J Anaesth. 1995;75:642-53.
Myers MA, Harmon RL. Sacral plexopathy and sciaticneuropathy after total knee arthroplasty. Electro Clin Neurophysiol. 1998;38:423.
Nicholson MJ, Everson UH. Neurologic complications of spinal anesthesia. J Am Med Asso. 1946;132:679-85.
Jooma R, Hayward RD. Upward spinal coning: impaction of occult spinal tumors following relief of hydrocephalus. J Neurol Neurosurg Psychiatry. 1984;47:386-90.
Hollis PH, Malis LI, Zappulla RA. Neurological deterioration after lumbar puncture below complete spinal subarachnoid block. J Neurosurg. 1986;64:253-6.
Insall JN. Surgical techniques and instrumentation in total knee arthroplasty. IN Insall JN, Windsor RE, Scott WN, Kelly MA, Aglietti P. editors. Surgery of the knee. New York: Churchill Livingstone;1993:739-804
Krackow KA, Weiss APC. Recurvatum deformity complicating performance of total knee arthroplasty. A brief note. J Bone Joint Surg. 1990;72:268-71.