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Case Report

Posterior Knee Dislocation Following a Knee Arthroplasty

Introduction: Total knee arthroplasty is one of the most commonly performed surgeries in the United States. Complications following knee arthroplasty are uncommon, especially dislocations. Knee dislocations can be associated with popliteal artery injuries which are potentially catastrophic and limb threatening. All patients with known or suspected knee dislocation require an emergent orthopedic surgery consultation and vascular evaluation, although the type of evaluation remains controversial. Emergency Department (ED) physicians should be familiar with the management of knee dislocations and complications following total knee arthroplasty.

Case Report: A 61 one year old female presented to the ED with acute right knee pain approximately 10 weeks after undergoing a total knee replacement for tricompartmental osteoarthritis. At her 9 week post-op appointment, she was noted to have quad weakness and atrophy. While at her first outpatient physical therapy evaluation, the patient sustained a low-energy fall onto a flexed knee. Subsequently, she endorsed a popping sensation and was unable to bear weight or extend the knee. On exam, she is in obvious pain, her surgical scar is well healed and her knee is flexed to about 90 degrees and will not extend any further. She has a palpable dorsalis pedis pulse and brisk capillary refill. A stat radiograph reveals a posterior dislocation of her tibial prosthesis relative to her femoral prosthesis.

Conclusion: Under procedural sedation, the patient was reduced and placed in a knee immobilizer. Her neurovascular exam is intact pre and post- reduction. Several months later she experienced another episode of spontaneous dislocation during a routine office visit requiring a second ED visit for reduction under procedural sedation. She is subsequently scheduled to undergo a revision of her total knee replacement due to suspected flexion instability with an inadequate extensor mechanism.

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Correspondence

A Brief Report on the Beirut Port Explosion

Over the past year, Beirut has witnessed a civil revolution, the COVID-19 pandemic, its worst economic crisis in decades, and most recently one of the largest non-nuclear explosions in history. This explosion had devastating effects on the city’s social, economic, and health infrastructure.

Review Article

Can Ultrasound Aid in the Diagnosis of Gout and Septic Arthritis in the Setting of Monoarticular Joint Pain?

Monoarticular joint pain is commonly encountered in the emergency department (ED) with a broad differential diagnosis. Septic arthritis represents a “can’t miss” diagnosis while gout represents a chronic, painful arthropathy. Traditionally these diagnoses are made with arthrocentesis in addition to history, physical exam, imaging and laboratory studies. Ultrasound (US) represents a novel modality that may aid in the diagnosis of gout without requiring arthrocentesis. Furthermore, the sonographic features of gout may exclude the diagnosis of septic arthritis. Additional research is required in the ED setting to better clarify the role of US in these two disease states.

Special Contribution

Reforming Healthcare Practice in View of the Economic Crisis in Lebanon: The Case of Cardiovascular Care

Since the fall of 2019, Lebanon has been facing an economic crisis that has imposed many challenges on its healthcare system in its entirety. In this review, we propose a methodology to inform healthcare policy and apply it on cardiovascular disease (CVD) healthcare with emphasis on ischemic heart disease (IHD). The main goal of this methodology is reducing unnecessary expenditure while maintaining quality and access. CVD, and particularly IHD, is the most common reason for hospitalizations in Lebanon. Lebanon also has a high density of catheterization labs, higher than countries with higher prevalence of disease. Additionally, we found coronary to be are more expensive in comparison to other countries. To reduce healthcare costs without compromising quality and access we propose solutions targeting healthcare financing, payment for services, healthcare organizations, behaviors of providers, payers, and patients, and above all government regulation.