SKINTED: an uncommon cutaneous complication of total knee replacement

Surgery of the knee, injury to the infrapatellar branch of the saphenous nerve, traumatic eczematous dermatitis (SKINTED) involving the skin lateral to the surgical incision/scar area is a site- and procedure-specific diagnosis associated with total knee replacement surgery. It results from autonomic denervation following surgical trauma to the nerve and occurs months to years after surgical trauma. It needs to be differentiated from post traumatic eczema/dermatitis, neuropathic dermatitis and contact dermatitis/sensitization due to topical therapies or implant material. Herein, we report a case of 70-year-old woman having no preexisting medical or dermatological disorder of significance presenting with eczematous lesions around both knees lateral to the incision site developing few months after bilateral total knee replacement surgery. Treatment with twice daily application of betamethasone dipropionate 0.05% cream, gabapentine 100 mg/d PO and liberal use of bland emollient cream given over 2 months was remittive without recurrence during more than one year of follow up. Since its exact prevalence, pathophysiology and clinical course remain uncertain its awareness remains relevant to both dermatologists and orthopedic surgeons to address unnecessary anxiety and dissatisfaction of the patient.