Localised bullous pemphigoid overlying knee arthroplasty: a diagnostic challenge

An elderly Caucasian woman developed bullous pemphigoid (BP) overlying the site of total knee arthroplasty for osteoarthritis 2 days after surgery. The clinical findings were consistent with blistering due to soft tissue swelling, bullous impetigo or allergic contact dermatitis. The blistering spread over weeks to months down the ipsilateral leg and then to the other leg and hips. A biopsy for H&E and direct immunofluorescence established the diagnosis of BP. A concomitantly occurring wound infection was identified and treated. The blistering responded well to superpotent topical steroids and local care.

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Localized Bullous Pemphigoid on the Site of Knee Arthroplasty: A Case Report

Serbian Journal of Dermatology and Venerology ◽

10.1515/sjdv-2016-0004 ◽

2016 ◽

Vol 8 (1) ◽

pp. 39-44 ◽

Cited By ~ 1

Author(s):

Lucija Kosi ◽

Jelena Perić ◽

Milica Pantović ◽

Gorana Bijelić ◽

Jelica Vukićević Sretenović ◽

...

Keyword(s):

Bullous Pemphigoid ◽

Knee Arthroplasty ◽

Skin Lesions ◽

Direct Immunofluorescence ◽

Topical Steroids ◽

Cutaneous Lesions ◽

Predisposing Factor ◽

Dermatological Examination ◽

The Right ◽

Split Skin

Abstract Localized bullous pemphigoid is a rare variant of bullous pemphigoid, and its exact etiopathogenesis is yet to be elucidated. We present a case of a 74-year-old Caucasian male with a 3-month history of skin lesions that appeared 9 months after he underwent a knee arthroplasty. Dermatological examination showed several pruritic tense bullae on the right knee, localized around the surgical scar, as well as erosions covered with crusts. The diagnosis of localized bullous pemphigoid was confirmed by direct immunofluorescence test (conventional and split-skin). The patient was treated with potent topical steroids, which led to complete resolution of cutaneous lesions. We suppose that the occurrence of localized bullous pemphigoid in our patient may be explained by the concept of “immunocompromised district” in which one disease (surgery) caused an immunological alteration which is a predisposing factor for the development of secondary disease such as localized bullous pemphigoid.

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Allergic Contact Dermatitis to Dermabond (2-Octyl Cyanoacrylate) After Total Knee Arthroplasty

Dermatitis ◽

10.1097/der.0000000000000018 ◽

2014 ◽

Vol 25 (2) ◽

pp. 99-100 ◽

Cited By ~ 20

Author(s):

Dunnett Durando ◽

Caitlin Porubsky ◽

Suzanne Winter ◽

JoEllen Kalymon ◽

Thomas O’Keefe ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Contact Dermatitis ◽

Allergic Contact Dermatitis ◽

Knee Arthroplasty ◽

Total Knee ◽

Allergic Contact

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Patellar tracking in primary total knee arthroplasty

EFORT Open Reviews ◽

10.1302/2058-5241.3.170036 ◽

2018 ◽

Vol 3 (4) ◽

pp. 106-113 ◽

Cited By ~ 4

Author(s):

Simon Donell

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Recent Literature ◽

Primary Total Knee Arthroplasty ◽

Clinical Findings ◽

Patellar Tracking ◽

Patellar Kinematics ◽

Total Knee ◽

Primary Total Knee ◽

Normal Laboratory

This is a review of the recent literature of the various factors that affect patellar tracking following total knee arthroplasty (TKA). Patellar tracking principally depends on the pre-existing patellar tracking and the rotational alignment of the femoral and tibial implants, but the detailed movements depend on the patellar shape. The latter means that the patellar kinematics of any implanted TKA does not return to normal. Laboratory cadaveric studies use normal knees and non-activity-based testing conditions and so may not translate into clinical findings. The recent literature has not added anything significant to change established clinical practice in achieving satisfactory patellar tracking following TKA. Cite this article: EFORT Open Rev 2018;3:106-113. DOI: 10.1302/2058-5241.3.170036.

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Spontaneous Heparin-Induced Thrombocytopenia and Venous Thromboembolism following Total Knee Arthroplasty

Case Reports in Hematology ◽

10.1155/2017/4918623 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Kevin Baker ◽

Ming Y. Lim

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Heparin Therapy ◽

Caucasian Woman ◽

Functional Assay ◽

Heparin Infusion ◽

Heparin Induced Thrombocytopenia ◽

Vein Thrombosis ◽

Total Knee ◽

Deep Vein

A 72-year-old Caucasian woman was admitted for an elective left total knee arthroplasty. Her surgery was uncomplicated and she was discharged to a rehabilitation facility. Twelve days later, she developed acute shortness of breath followed by a syncopal episode. She was hypoxic and cyanotic, requiring hospitalization and intubation, and was subsequently diagnosed with bilateral submassive pulmonary emboli and bilateral lower extremity deep vein thrombosis. She was started on unfractionated heparin infusion. Within 24 hours of exposure, she had an acute decrease in platelet count to 48,000. Heparin was discontinued and argatroban was initiated due to concern for heparin-induced thrombocytopenia (HIT). Both quantitative enzyme immunoassay and functional assay confirmed the diagnosis of HIT. The patient had no prior lifetime heparin exposure. Given the absence of preceding heparin therapy, this case is consistent with the diagnosis of spontaneous HIT.

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Pemphigus and Bullous Pemphigoid

10.2310/fm.1122 ◽

2020 ◽

Author(s):

Aakaash Varma ◽

Annette Czernik ◽

Jacob Levitt

Keyword(s):

Botulinum Toxin ◽

Bullous Pemphigoid ◽

Clinical Features ◽

Indirect Immunofluorescence ◽

Direct Immunofluorescence ◽

Topical Steroids ◽

Bladder Epithelium ◽

Paraneoplastic Pemphigus ◽

Rat Bladder ◽

Collagen Xvii

Pemphigus disorders are characterized by acantholysis, whereas pemphigoid disorders are characterized by a dermal-epidermal split. Diagnosis of pemphigus or pemphigoid relies on a combination of positive anti-desmoglein or anti-collagen XVII serology, confirmatory direct immunofluorescence, and clinical features. Treatment for immunobullous disease revolves around various immunosuppressants, most often some combination of rituximab, prednisone, and IVIg. Paraneoplastic pemphigus is characterized by hemorrhagic crusting of the lips with positive indirect immunofluorescence on rat bladder epithelium, which should prompt a search for malignancy. Hailey-Hailey disease is a genetically mediated pemphigus that typically occurs in skin folds and responds to a number of agents including botulinum toxin, topical steroids, and other anecdotal therapies. This review contains 17 figures, 2 tables, and 109 references. Keywords: blister, pemphigus, bullous, rituximab, bullae, prednisone

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Bullous Pemphigoid After Total Knee Arthroplasty

Arthroplasty Today ◽

10.1016/j.artd.2021.04.009 ◽

2021 ◽

Vol 9 ◽

pp. 53-57

Author(s):

Suleiman Sudah ◽

Christopher Michel ◽

Christopher Dijanic ◽

Daniel Kerrigan ◽

Mark Gesell

Keyword(s):

Total Knee Arthroplasty ◽

Bullous Pemphigoid ◽

Knee Arthroplasty ◽

Total Knee

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Overcoming the Technical Challenges of Total Knee Arthroplasty in Patients Affected by Hereditary Multiple Exostoses: Our Experience Managing the Bone Deformities

10.21203/rs.3.rs-542388/v1 ◽

2021 ◽

Author(s):

Eugenio Cammisa ◽

Domenico Alesi ◽

Amit Meena ◽

Giada Lullini ◽

Stefano Zaffagnini ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Clinical Results ◽

Caucasian Woman ◽

Hereditary Multiple Exostoses ◽

Patellar Maltracking ◽

Multiple Exostoses ◽

Ligament Instability ◽

Knee Deformity ◽

Total Knee

Abstract Introduction: Hereditary multiple exostoses (MHE), also known as familiar osteochondromatosis or diaphyseal aclasis, is an autosomal dominant inherited genetic pathology that is characterized by the presence of multiple benign osteochondromas (exostoses). Knee deformity is common in patients with HME, with nearly a third of patients developing genu valgus. Total knee arthroplasty (TKA) has been used to correct valgus deformities with advanced knee osteoarthritis (OA). However concomitant limb deformities and altered anatomy of the knee make this surgery particularly challenging.Case presentation: We present the case of a 50 years old Caucasian woman, affected by multiple hereditary exostoses, who came to our attention for progressive pain in the right knee. Upon further examination the knee had a prominent valgus alignment, concomitant valgus instability and flexion contraction. The patient was treated with one stage total knee arthroplasty using a semi-constrained design. The patient was re-evaluated at 24 months follow-up and there were no signs of implant loosening, the knee function improved significantly and the patient was very satisfiedConclusions: We also present a mini-review of the literature on this topic. Given the recurring technical difficulties of such procedure in these patients, we describe our experience as well as the need for preoperative planning, the use of appropriate constrain when required, the high frequency of ligament instability, bony defects, and patellar maltracking. TKA must be considered when necessary, in these patients, as good to excellent clinical results can be achieved and maintained, allowing for significant improvements in quality of life.

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Radiographic and clinical risk factors of total knee arthroplasty in asymptomatic knees; a 15-year follow-up study

10.1101/816462 ◽

2019 ◽

Author(s):

Flemming Kromann Nielsen ◽

Anne Grethe Jurik ◽

Anette Jørgensen ◽

Niels Egund

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Joint Space ◽

Clinical Findings ◽

Baseline Body Mass Index ◽

Knee Oa ◽

Symptomatic Knee ◽

Total Knee

AbstractBackgroundRadiographic signs of osteoarthritis (OA) are frequent in knees without symptoms. The long-term impact of these findings is not completely elucidated. We wanted to evaluate whether radiographic or clinical baseline findings are associated with the risk of total knee arthroplasty (TKA) in knees without symptomatic OA but with clinical OA of the other knee during a mean follow-up period of 15 years.MethodsA follow-up analysis was performed in 100 persons with unilateral, clinical knee OA according to the ACR (American College of Rheumatology) criteria, who participated in a clinical trial between 2000 and 2002. Baseline radiographs of the contralateral, non-symptomatic knee were available in 88 participants at follow-up. Data on TKA procedures were extracted from the Danish National Patient Register at follow-up. Radiographic and clinical findings were analyzed for associations with subsequent TKA.ResultsAt follow-up, 40% had received a TKA in their non-symptomatic knee. The risk of TKA was significantly associated with baseline joint space narrowing (risk ratio (RR) 1.6 (95% confidence interval (95% CI) 1.4 to 1.9)), osteophytes (RR 1.5 (95% CI 1.3 to 1.8)) and subchondral sclerosis (RR 2.4 (95% CI 1.6 to 3.7)). Among the clinical findings, only baseline body mass index (BMI) was significantly associated with the risk of TKA (RR 1.4 (95& CI 1.1 to 1.8)).ConclusionsRadiographic OA changes and BMI at baseline were significantly associated with the long-term risk of TKA in persons without symptomatic knee OA but with symptomatic OA in the contralateral knee, implying that radiographic OA findings are important prognostic factors regardless of symptoms.

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