The journal of knee surgery
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Tumors of the peripheral nerve sheath including schwannomas are known for their rarity and can present with neurological deficit. We report an interesting case of schwannoma of the infrapatellar branch of saphenous nerve presenting with anteromedial knee pain and proximal tibial metaphyseal defect. A 26-year-old man presented with pain and swelling (for the past 2 months) in the anteromedial aspect of knee. ⋯ Histopathological examination confirmed benign schwannoma and the patient became symptom-free after the surgery. Schwannoma of the infrapatellar branch of saphenous nerve can present with anteromedial knee pain. In patients with an eccentrically placed metaphyseal defect of the anteromedial tibia with sclerosed smooth margins, the possibility of nerve sheath tumors should always be considered.
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Primary or revision total knee arthroplasties (TKAs) may be associated with a marked amount of intraoperative or postoperative blood loss that potentially may lead to the need for blood transfusions. However, Jehovah's Witnesses usually refuse blood transfusions because of their religious beliefs. ⋯ In this report, we provide an overview of various potential preoperative, intraoperative, and postoperative blood management measures that may be used for the care of Jehovah's Witnesses who undergo knee arthroplasty procedures. In addition, we review reported outcomes of primary and revision TKAs in these patients.
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Elective total knee arthroplasty is frequently associated with considerable blood loss and a concomitant decline in hemoglobin postoperatively. This often leads to high rates of allogeneic transfusions, with reports of up to 69%, to treat postoperative anemia. Allogeneic blood transfusions have been shown to be an independent risk factor for increased adverse outcomes, such as prolonged length of hospital stay and postoperative infections. ⋯ Specifically, we evaluated preoperative autologous blood donation, iron therapy, and intravenous erythropoietin. Current evidence suggests that these techniques independently may be effective at reducing the incidence of allogeneic blood transfusions, correcting preoperative, and preventing postoperative anemia. However, more studies are necessary to evaluate combination protocols, as well as the cost-effectiveness and safety of these practices as part of routine preoperative blood management for total knee arthroplasty.
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We present a case of a 24-year-old, otherwise healthy, man who sustained a right knee injury after a fall. A small, comminuted inferior pole patella fracture with medial and lateral retinacular tears was encountered that required a small, nonarticular partial patellectomy and patellar tendon repair. ⋯ The patellar tendon was reconstructed with semitendinosus and gracilis autograft. At 1 year follow-up, the patient had regained a normal gait, had no pain, and had full range-of-motion without extensor lag.
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Acute inferior dislocation of the patella is rare but has been documented. However, there has been no published report of inferior dislocation of the patella following a total knee replacement (TKR). A 62-year-old man underwent a posterior cruciate retaining TKR Anatomic Graduated Component (AGC) (Biomet, Warsaw, IN) without patellar resurfacing. ⋯ Closed reduction under anesthesia failed and open reduction with debridement of the osteophytes resulted in excellent patellar tracking and a good functional result without any recurrence. Surgeons need to be aware of this rare complication of acute locked knee following TKR which may require open reduction. Also, the debridement of the osteophytes or even a resurfacing of the patella may be a more definitive solution to such patellofemoral problems.