Abstract

Unusual Severe Soft Tissue Necrosis Following Exposure of Metal Implants in Total Knee Replacement: A Case Report

Introduction: Complications, such as thromboembolism, infection, periprosthetic fracture, and soft-tissue necrosis are commonly encountered in cases of total knee arthroplasty. The risk of developing complications is higher in patients with comorbidities, including diabetes mellitus (DM) and hypertension. Soft tissue necrosis can be managed through local wound care, frequent dressing change, surgical debridement, and tissue flap accordingly. Case report: In this report, we describe the case of an obese, 65-year-old bed-ridden female, a known case of hypertension, DM and hypothyroidism with stable vital signs. She underwent bilateral total knee replacement for severe osteoarthritis of her knees. During the 8th week post-operatively of her left knee, the patient developed sloughing of the wound and was admitted through the emergency under orthopedic care. She was diagnosed with soft tissue necrosis and treated with irrigation and debridement. She also administered a course of intravenous antibiotics. During her hospitalization, the orthopedic and plastic surgery teams were involved and the patient underwent multiple irrigation and debridement and implant removal followed by coverage of the wound with a partial thickness skin graft. Conclusion: Extensive antibiotics course, multiple irrigation and debridement, and arthrodesis over a period of less than 3 months has successfully salvaged the patient’s limb.

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