A Sixty-One-Year-Old Woman with Ischemia After Total Knee Arthroplasty: A Case Report.

Abstract

Arterial complications after total knee arthroplasty are rare, but potentially devastating. Most cases are attributable to predisposing patient risk factors and iatrogenic trauma or manipulation1. Numerous causes, such as thrombosis, vessel severance, aneurysm, and plaque embolization, have been reported in the literature1-4, and the anatomic relationships in the popliteal fossa have been well-described5. We present a case of acute ischemia after total knee arthroplasty associated with position-dependent occlusion of the popliteal artery. The contributing factors included a common underlying patient condition and a frequently used femoral component design. Orthopaedic surgeons that perform total knee arthroplasty regularly should be cognizant of the hallmark presentation of this complication, the appropriate clinical workup, and the optimal treatment options. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A sixty-one-year-old woman presented with acute right leg ischemia in the postoperative recovery unit after routine cemented total knee arthroplasty for osteoarthritis. She had symptoms of marked pain and weakness throughout the leg. Surgery had been performed via a standard medial parapatellar approach with a tourniquet in place. An LPS-Flex Fixed Bearing implant system (Zimmer, Warsaw, Indiana) with a size 5 tibial baseplate, 29-mm patella, 14-mm polyethylene insert, and size F gender-specific femoral component had been used. Preoperative templating for size and alignment as well as intraoperative bone resection had been facilitated by the Patient Specific Instrumentation (PSI) system (Zimmer). The posterior osteophytes had been removed to achieve full knee extension, and soft-tissue balancing had included subperiosteal elevation of the posterior oblique ligament, deep medial collateral ligament, and semimembranosus tendon insertion. The patient’s medical history included hypertension, coronary artery disease, and carotid artery disease. She denied exertional chest pain or lower-extremity claudication. The remainder of the history was noncontributory. …