Global instability following primary total knee arthroplasty in patient with osteoarthritis and backache due to missed thoracic meningioma: our experience

Recurvatum or hyperextension instability with bladder dysfunction and impeded walking after total knee arthroplasty due to a thoracic meningioma that was not detected on preliminary neurological evaluation (clinco-radiological) in an osteoarthritic patient with complaint of backache, muscle weakness and claudication. Magnetic resonance imaging (MRI) whole spine revealed a thoracic mass at the level D2-3. Complete resection of spinal mass was done. The knee was revised with rotating hinge prosthesis following spinal surgery. The diagnosis requires an algorithmic approach to identify the cause and best available management options. It is strongly suggested that thorough neurological examination of whole spine should be done preoperatively if lumbar imaging is unconvincing or is incompatible with the history and clinical examination to prevent such serious complications.