Early, posttraumatic, frontal instability of the knee joint deriving from damaged medial collateral ligament, after total knee arthroplasty, complicated with wound dehiscence and Clostridium difficile infection in a 70-year-old patient

Potoczniak Bartosz, Dziedzic Artur, Kosior Piotr, Bąk Marcin, Blicharski Tomasz, Massalska-Małecka Teresa, Jarecki Jaromir. Early, posttraumatic, frontal instability of the knee joint deriving from damaged medial collateral ligament, after total knee arthroplasty, complicated with wound dehiscence and Clostridium difficile infection in a 70-year-old patient. Journal of Education, Health and Sport. 2019;9(2):192-198. eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.2561234

http://ojs.ukw.edu.pl/index.php/johs/article/view/6576

https://pbn.nauka.gov.pl/sedno-webapp/works/903575

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© The Authors 2019;

This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland

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The authors declare that there is no conflict of interests regarding the publication of this paper.

Received: 30.01.2019. Revised: 30.01.2019. Accepted: 10.02.2019.

Early, posttraumatic, frontal instability of the knee joint deriving from damaged medial collateral ligament, after total knee arthroplasty, complicated with wound dehiscence and Clostridium difficile infection in a 70-year-old patient

Bartosz Potoczniak¹, Artur Dziedzic¹, Piotr Kosior¹, Marcin Bąk¹, Tomasz Blicharski², Teresa Massalska-Małecka³, Jaromir Jarecki^1,2

¹ Trauma and Orthopedic Ward with Spinal Surgery, Independent Public Province Specialist Hospital, Chełm, Poland

² Orthopedic and Rehabilitation Clinic, Independent Public Clinical Hospital No.4 in Lublin, Lublin, Poland

³ Human Physiology Department, Medical University of Lublin, Lublin, Poland

Correspondence: Bartosz Potoczniak, Trauma and Orthopedic Ward with Spinal Surgery, Independent Public Province Specialist Hospital, ul. Ceramiczna 1, 22-100 Chełm, Poland. Tel: 0048-600870701

E-mail: b.potoczniak@gmail.com

Abstract

Gonarthrosis is a joint disease in which a balance between regenerative and degenerative processes of articular cartilage is impaired. Its main symptoms are: pain, swelling, rigidity, function restraint as well as articular deformation [1]. It is estimated that about 40% of the knee joint degeneration is a consequence of ageing of the body. 60% of remaining cases
of gonarthrosis is a result of excessive strain, contusion and injury. Patients with advanced arthrosis are qualified for total arthroplasty of the knee. Medial collateral ligament (MCL) is responsible for the medial stability of the knee joint, it prevents from valgus deformity and restraints external rotation of tibia relative to the femur. Injury, most often distorting the knee, may lead to straining as well as complete rupture of the MCL [2,3]. We present a case of a 70-year-old patient with MCL injury that happened three weeks after total knee arthroplasty, complicated by wound dehiscence. Insufficiency of the medial collateral ligament in our patient had an effect in longer healing process and rehabilitation. Main treatment options are: revision surgery with use of constrained implants and injured medial collateral ligament reconstruction. Constrained implants may have reduced longevity in some patients through aseptic loosening. Our patient underwent a MCL reconstruction. Reconstruction of MCL without revision arthroplasty has good results for injured MCL after total arthroplasty of the knee.

Keywords: gonarthrosis, total knee arthroplasty, chronic wound, medial collateral ligament, VAC