Neuropathic dermatitis : Case series of a newly identified dermatological complication after total knee arthroplasty

Abstract

Introduction: Development of skin lesion after TKA is an uncommon yet disturbing phenomenon, and rarely studied in literature. We described a case series of a newly identified dermatological complication after TKA. Methodology: During a 1-year period, patient who developed skin lesion after TKA is identified and their history and nature of the skin lesion were studied. Results and Analysis: A total of 21 cases were identified in the study period. All presented with eruption exclusively at the site of surgical excision and nearby skin. Appearance of the lesion range from multiple patchy areas of eczematous rash to large area of scaly plaque or pigmentation. Most lesion developed at around 3 months postop. All patients had normal perioperative course and there was no history of allergy nor topical medication use. While a few eczematous lesion improved after steroid therapy, most lesion persisted as chronic lesion. Discussion and Conclusion: The underlying pathogenesis of this lesion is likely contributed by denervation injury due to transection of infrapatellar branch of saphenous nerve, which leads to hypoesthesia and cutaneous eruption due to dysfunction of normal skin barrier homeostasis. This group of dermatitis is incorporated under the newly defined clinical entity known as neuropathic dermatitis or autonomic denervation dermatitis, with estimated prevalence around 3.1% from this study. Surgeon should recognize this potential complication and patient adequately counseled about the chronicity of this lesion.