Infection following total knee arthroplasty can be devastating. Even with established treatment protocols, eradication of the infection may not be feasible. We report 2 patients who required above-knee amputation to eradicate recalcitrant infection.
We report a case of sciatic nerve entrapment resulting in a patient experiencing pain over the posterior aspect of the knee, simulating a Baker's cyst. Surgical exploration revealed a tight fibrous arch compressing the distal portion of the sciatic nerve, proximal to its bifurcation. Decompression of this entrapment led to complete relief of symptoms. This form of presentation is rare and should be considered as a differential diagnosis when a patient presents with complaints of pain in the back of the knee. Keywords: Sciatic nerve compression, pain in the back of the knee
Medicine and healthcare can rightly be considered as High Reliability Organization (HRO) when it strives to promote and maintain reproducible and safe outcomes for all patients. Situational awareness (SA) as a concept meant to augment patient safety has often been discussed in the literature, but our own local contribution to this important discussion is decidedly deficient. Being initially implemented in the aviation industry, this concept has been extended to be a crucial element in high-demand activities, including healthcare. As such, extensive exposure is given early on during the training of medical personnel in many countries. We believe that our own medical students and other healthcare candidates in training should be similarly exposed to this concept as it can have a tremendous impact on patient well-being and safety. This paper attempts to provide a short overview of the SA in healthcare and how we can similarly promote its inclusion in our training programmes.
We attempted to compare the accuracy of our clinical examination and the usage of magnetic resonance imaging (MRI) in evaluating patients suspected of having internal derangement of the knee who were seen in our Orthopaedic clinic. This was done using the findings of arthroscopy as the 'gold standard'. The accuracy of MRI in detecting cruciate ligament tears was between 80-96% against 82-93% for clinical examination. MRI accuracy for meniscus injuries was 80-84% compared to 48-65% for clinical examination. We thus propose that MRI examination is an effective first-line investigation for patients with suspected internal knee derangement, especially menisci injuries; allowing arthroscopy to be reserved for patients in whom surgery is truly indicated.
Study site: Orthopedic clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)