Gentamicin allergy as an unexpected ‘hidden’ cause of complications in knee arthroplasty

Gentamicin allergy as an unexpected ‘hidden’ cause of complications in knee arthroplasty In patients with complications after arthroplasty, common potential causes, such as malpositioning, mechanical problems, or infections, are usually investigated first. After exclusion of such causes, or in cases of local eczema, implant allergy might be suspected. We report a patient who developed pain and swelling of the knee with subsequent local eczema after cemented total knee arthroplasty.Case ReportA 79‐year‐old patient had received a right cemented total knee arthroplasty in November 2013. Initially, full recovery and uncomplicated performance of the endoprosthesis was reported. In February 2014, however, pain, swelling and a reduced range of motion were noted after an extended walk. Physical examination by the orthopaedic surgeon showed joint effusion. Subsequent computed tomography showed a correct implant position without any signs of loosening. Diagnostic joint aspiration and microbiological analysis showed no signs of infection. Scintigraphy was suggestive of local synovitis. Thus, synovitis caused by ‘excessive walking’ was diagnosed, and oral diclofenac was prescribed. However, the patient complained of increasing pain, and presented with local eczema of the right knee a few weeks later (Fig. ).Patient with a painful knee arthroplasty and local eczema.Allergy diagnostics were initiated, including patch testing with the baseline series, supplemental series, including a metal series, and http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Contact Dermatitis Wiley

Gentamicin allergy as an unexpected ‘hidden’ cause of complications in knee arthroplasty

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Publisher
Wiley
Copyright
© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
ISSN
0105-1873
eISSN
1600-0536
D.O.I.
10.1111/cod.12930
Publisher site
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Abstract

In patients with complications after arthroplasty, common potential causes, such as malpositioning, mechanical problems, or infections, are usually investigated first. After exclusion of such causes, or in cases of local eczema, implant allergy might be suspected. We report a patient who developed pain and swelling of the knee with subsequent local eczema after cemented total knee arthroplasty.Case ReportA 79‐year‐old patient had received a right cemented total knee arthroplasty in November 2013. Initially, full recovery and uncomplicated performance of the endoprosthesis was reported. In February 2014, however, pain, swelling and a reduced range of motion were noted after an extended walk. Physical examination by the orthopaedic surgeon showed joint effusion. Subsequent computed tomography showed a correct implant position without any signs of loosening. Diagnostic joint aspiration and microbiological analysis showed no signs of infection. Scintigraphy was suggestive of local synovitis. Thus, synovitis caused by ‘excessive walking’ was diagnosed, and oral diclofenac was prescribed. However, the patient complained of increasing pain, and presented with local eczema of the right knee a few weeks later (Fig. ).Patient with a painful knee arthroplasty and local eczema.Allergy diagnostics were initiated, including patch testing with the baseline series, supplemental series, including a metal series, and

Journal

Contact DermatitisWiley

Published: Jan 1, 2018

Keywords: ; ; ; ; ; ;

References

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