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Multi-ligament instability after early dislocation of a primary total knee replacement - case report
Krisztian Sisak1, John Lloyd, Nick Fiddian
1The Royal Bournemouth Hospital, United Kingdom. sisakkrisztian@hotmail.com
The Knee
|January 7, 2010
Summary
Peripheral nerve blocks (PNB) offer effective pain relief after total knee replacement. While a rare knee dislocation occurred during PNB use, they remain safe, but patient mobilization needs careful monitoring.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Pain Management
Background:
- Peripheral nerve blocks (PNB) are increasingly used for post-operative analgesia in total knee replacement (TKR), offering advantages over epidural anesthesia.
- PNB provide effective pain management with a generally favorable safety profile for TKR patients.
Observation:
- A case of acute low-energy knee dislocation occurred post-primary total knee replacement despite the patient receiving combined femoral and sciatic nerve blocks.
- The dislocation happened while the peripheral nerve blocks were still active and was not associated with neurovascular compromise.
- The patient subsequently required a revision total knee replacement due to collateral ligament and posterior cruciate ligament complex injuries.
Findings:
- Review of incidence indicates peripheral nerve blocks are safe and effective for TKR analgesia.
- The reported knee dislocation was an isolated event, not directly caused by the nerve block itself.
- Peripheral nerve blocks did not mask or cause the dislocation.
Implications:
- Peripheral nerve blocks remain a safe and effective analgesic option for total knee replacement surgery.
- Enhanced patient and staff education is crucial to prevent premature mobilization after PNB, ensuring muscle control is regained.
- Close monitoring for potential complications, including joint instability, is essential even with effective analgesia.