Anterior prosthetic knee dislocation with acute vascular injury: A case report

INTRODUCTION: and Importance: Anterior dislocation of a prosthetic knee is rarely encountered. Acute vascular injury following anterior prosthetic dislocation has only been reported once in the literature with extremely poor outcomes. CASE PRESENTATION: The authors report the case of a 70-year-old woman who presented with anterior prosthetic knee dislocation after a fall from slipping. After closed reduction, CT angiography found transection and active extravasation of the left popliteal artery. An emergent fasciotomy and popliteal bypass were performed with concurrent external fixation of the joint. Recovery was complicated by bacteremia requiring eventual explant of total knee arthroplasty (TKA). CLINICAL DISCUSSION: We report the only case of successful vascular repair after acute vascular injury from traumatic anterior prosthetic dislocation. External fixation of the knee allowed for better stabilization of the joint and preservation of the repaired vascular injury; however, it carries a risk for infection, as seen in this case. CONCLUSIONS: While there are no clear guidelines for management, we highlight the importance of rapid diagnosis with CT angiography and shared decision making with the vascular surgery team to repair the injury and stabilize the joint.