180° rotatory dislocation of the rotating platform of a posterior-stabilized mobile-bearing knee prosthesis; possible complication after closed reduction of a posterior dislocation--a case report

Abstract

Dislocation of the rotating platform is a significant early complication of mobile-bearing total knee arthroplasty. The authors report an unusual case of acute 180° rotatory dislocation of the rotating platform after closed reduction of a posterior dislocation of a posterior-stabilized mobile-bearing total knee prosthesis. A 71-year-old male with knee osteoarthritis underwent TKRA using a posterior-stabilized mobile-bearing prosthesis. Posterior dislocation of the prosthesis occurred at 5 weeks postoperatively, and closed reduction of the posterior dislocation resulted in complete 180° rotatory dislocation of the rotating platform. The patient was treated by open exploration and polyethylene exchange for a larger component. This case illustrates that dislocation of a posterior-stabilized mobile-bearing total knee prosthesis can occur given valgus laxity and causes a 90° spin-out of the polyethylene insert, and that closed reduction attempts may contribute to complete 180° rotatory dislocation of the rotating platform. Special attention should be given to both AP and lateral views to ensure that the platform is truly reduced and not rotated by 180°. Plain digital radiography, which enhances the density of polyethylene, or arthrography is helpful for diagnosing this complication.

Keywords: Dislocation; Mobile-bearing; Posterior-stabilized; Rotating platform; Spin-out; Total knee arthroplasty.