Revision Total Knee Arthroplasty for Ballistic Component Damage From an Intra-articular Missile

Andrew A Palosaari; Peter Z Berger; Benjamin D Gross; Safa C Fassihi; Joshua C Campbell

doi:10.1016/j.artd.2023.101172

Revision Total Knee Arthroplasty for Ballistic Component Damage From an Intra-articular Missile

Arthroplast Today. 2023 Jul 22:22:101172. doi: 10.1016/j.artd.2023.101172. eCollection 2023 Aug.

Authors

Andrew A Palosaari^{1

2}, Peter Z Berger¹, Benjamin D Gross², Safa C Fassihi¹, Joshua C Campbell¹

Affiliations

¹ Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA.
² Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.

Abstract

Gunshot wounds (GSWs) and total knee arthroplasty (TKA) are increasingly common, yet a GSW to a TKA is a rare injury. A 60-year-old man sustained an intra-articular GSW to a prior TKA. The patient was scheduled for irrigation and debridement with polyethylene liner exchange. Intraoperatively, the new polyethylene liner was unable to engage the tibial tray. Damage to the locking mechanism on the tibial tray was suspected so total revision proceeded. Upon inspection of the explanted components, it was noted that a bullet fragment offline from the missile trajectory had blocked the locking of the polyethylene liner in the tibial tray. Expeditious antibiotics should be given and meticulous debridement should be performed to avoid unnecessary total component revision.

Keywords: Gunshot wound; Revision arthroplasty; Total knee arthroplasty.

Publication types

Case Reports