Compartment syndrome after total knee arthroplasty: regarding a clinical case

Abstract

Although compartment syndrome is a rare complication of total knee arthroplasty, it is one of the most devastating complications. It is defined as a situation of increased pressure within a closed osteofascial space that impairs the circulation and the functioning of the tissues inside this space, thereby leading to ischemia and tissue dysfunction. Here, a clinical case of a patient who was followed up in orthopedic outpatient consultations due to right gonarthrosis is presented. The patient had a history of arthroscopic meniscectomy and presented knee flexion of 10° before the operation, which consisted of total arthroplasty of the right knee. The operation seemed to be free from intercurrences, but the patient evolved with compartment syndrome of the ipsilateral leg after the operation. Since compartment syndrome is a true surgical emergency, early recognition and treatment of this condition through fasciotomy is crucial in order to avoid amputation, limb dysfunction, kidney failure and death. However, it may be difficult to make the diagnosis and cases may not be recognized if the cause of compartment syndrome is unusual or if the patient is under epidural analgesia and/or peripheral nerve block, which thus camouflages the main warning sign, i.e. disproportional pain. In addition, edema of the limb that underwent the intervention is common after total knee arthroplasty operations. This study presents a review of the literature and signals that the possible rarity of cases is probably due to failure to recognize this condition in a timely manner and to placing these patients in other diagnostic groups that are less likely, such as neuropraxia caused by using a tourniquet or peripheral nerve injury.

Superficial femoral artery pseudoaneurysm, compartment syndrome, and deep vein thrombosis after total knee arthroplasty

“…Most complications in TKA are diagnosed in the first 24 to 48 hours, allowing for early treatment and avoiding the need of amputation, contrary to what happened in our case [2][3][4][5]7,8,10,11,15,16]. Nonetheless, despite optimal management of complications following early diagnosis, there can be loss of functionality, such as foot drop and articular rigidity, or requirement of external aids for mobility, and the quality of life of patients can get compromised [6,7,9,17].…”

“…They also explain the generation of diverse symptoms that may or may not lead to an early and adequate diagnosis that could allow for appropriate treatment. Similarly, vascular lesions can also present with compartment syndrome, which, by itself, is highly rare after TKA and even rarer in association with vascular trauma, leading to increased morbidity [6][7][8][9]. This study presents a case with no clear etiology for vascular injury after TKA and how it was managed.…”

“…There are also reports on the use of tourniquet producing proximal artery injury, especially in the femoral artery [4,11], as well as on adductor canal blockage with posterior hematomas and pseudoaneurysms during endovascular procedures [12][13][14]. Literature has also reported cases in which an etiology has not been found [4,6,15]. In such cases, the theories proposed to explain the development of a vascular lesion including the following: 1.…”

Coil embolization of an aberrant posterior tibial artery pseudoaneurysm after total knee arthroplasty

“…The most invasive option is open, direct surgical repair of the artery with decompression of the associated hematoma 5 . This is certainly necessary in the presence of a hard indication for surgical decompression, such as compartment syndrome 14 . However, minimally invasive treatment options are available and appealing because of a lower potential for wound complications.…”

Regional anesthesia or patient-controlled analgesia and compartment syndrome in orthopedic surgical procedures: a systematic review

“…89 Two others were case reports on adults, one with an upper extremity nerve block for distal radius fracture that did not delay the diagnosis of CS and the other a total knee arthroplasty that had an epidural for postoperative pain control that was removed after 24 hours who had CS diagnosed after 48 hours. 90 , 91 Pinheiro et al 91 states that though the epidural described above contributed to the delayed diagnosis of CS, it was not the sole cause of the delay.…”