Chronic Knee Dislocation After Total Knee Arthroplasty

Knee dislocation after total knee arthroplasty (TKA), although rare, is a dangerous injury that can lead to neurovascular compromise and permanent disability. Chronic dislocation after TKA is even less common and is defined as dislocation that is present for 4 weeks or more. There are few reports of its management. Chronic dislocation may be complicated further by concomitant extensor mechanism disruption, ligamentous instability, and/or capsular contracture. This article describes 3 cases of chronically dislocated TKAs and the challenges encountered in treating this difficult problem. A higher level of constraint was required to maintain knee stability, and an extensor mechanism allograft was needed in 2 of the 3 reported patients. The preferred technique at the authors' institution is a complete allograft composite, tensioned in full extension. In the setting of a chronically dislocated TKA, the authors now recommend revision surgery with an enhanced measure of constraint (constrained condylar device or hinged knee prosthesis), reconstruction of the extensor mechanism when necessary, and restoration of the joint while compensating for concomitant bony defects. Even when surgeons follow these principles, it is important to inform the patient that long-term outcomes will likely be inferior to those of revision surgery for other causes.