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. 2023 Jan 30;57(3):445-452.
doi: 10.1007/s43465-023-00835-4. eCollection 2023 Mar.

Neuropathy Dermatitis: An Underdocumented Complication Following Total Knee Arthroplasty

Ravikumar Mukartihal  1 , Rajesh Kumar Rajnish  2 , Phuljit Patowary  1 , Udit Kumar Biswal  1 , Pradeep A Ramesh  1 , Sharan Shivaraj Patil  3
Affiliations

Neuropathy Dermatitis: An Underdocumented Complication Following Total Knee Arthroplasty

Ravikumar Mukartihal et al. Indian J Orthop. .

Abstract

Background: Midline surgical incision used in Total Knee Arthroplasty (TKA) is associated with iatrogenic injury to the infrapatellar branch of the saphenous nerve, which leads to neuropathic dermatitis around the healed surgical scar. There are very few studies with a limited number of cases that have reported this complication. We evaluated the incidence of neuropathic dermatitis and its implication for the functional outcome in TKA patients.

Methodology: Patients who underwent primary TKA between 1 January 2010 and 31 August 2019 and presented in follow-up with sensory disturbances and skin lesions adjacent to the surgical incision were evaluated in this study.

Results: A total of 3318 patients with 4282 TKAs were included, of which 188 patients presented with the clinical picture of neuropathic dermatitis. There were 136 females and 52 males with a mean age of 67.13 years (range 37-92 years). The mean duration from surgery to the appearance of skin lesions was 4.4 months (range 2-6 months), and they resolved at a mean duration of 7.67 (range 6-12) weeks. In our study, we found an incidence of 5.52%. All these patients had a stable and well-functioning knee at the time of presentation of the lesion with a mean Knee Society Score (KSS) of 92 (range 84-96).

Conclusion: In our study, we found the incidence of neuropathic dermatitis to be 5.52%, without any long-term implication on the functional outcome of operated knees. For a self-limiting complication of midline knee incision of TKA, it either resolves on its own or requires a short duration of topical steroid application.

Keywords: Autonomic denervation dermatitis; Infrapatellar branch; Neuropathy dermatitis; SKINTED; Saphenous nerve; Total Knee Arthroplasty.

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Conflict of interest statement

Conflict of InterestThe authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A scaly erythematous skin lesion, right knee limited to lateral aspect of the healed midline surgical incision
Fig. 2
Fig. 2
Resolving scaly erythematous skin lesion, right knee limited to lateral aspect of the healed midline surgical incision
Fig. 3
Fig. 3
Resolving hyperpigmented scaly skin lesion over the right knee limited to lateral aspect of the healed midline surgical incision
Fig. 4
Fig. 4
A Bilateral knee involvement, right knee shows infected resolving skin lesion. B Left knee resolved skin lesion limited to lateral aspect of healed midline surgical incision
See this image and copyright information in PMC

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