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Compartment syndrome after total knee arthroplasty: regarding a clinical case.

Pinheiro AA, Marques PM, Sá PM, Oliveira CF, da Silva BP, de Sousa CM - Rev Bras Ortop (2015)

Bottom Line: Here, a clinical case of a patient who was followed up in orthopedic outpatient consultations due to right gonarthrosis is presented.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.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal.

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.

No MeSH data available.


Related in: MedlinePlus

Suturing of the fasciotomy sites was performed progressively and no skin grafts were necessary.
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fig0015: Suturing of the fasciotomy sites was performed progressively and no skin grafts were necessary.

Mentions: On the second day after the operation, the patient presented as neurologically superposed, without any vestige of motor activity below the knee. This led to the suspicion of neuropraxia of the anterior and posterior tibial nerve, with motor alterations provoked by the garrote. A postoperative control X-ray of the right knee was normal. The patient was kept under observation. On the same day, due to persistence of the hypoesthesia, pain in the proximal region of the lower leg and marked tension on the lateral face of the lower leg, the hypothesis of compartment syndrome was put forward and urgent fasciotomy was proposed, with exploration of the external popliteal sciatic nerve. The latter was explored and the anterolateral compartment of the lower leg was released. During the immediate postoperative period, hypoperfusion of the right lower limb was observed and fasciectomy of the four compartments of the right leg was performed. The patient underwent urgent computed tomography angiography on the right lower limb, which had normal findings and did not show any vascular lesions or space-occupying lesions. The care taken with the bandaging of the fasciotomy sites showed that there was necrosis of the muscles of the anterior and lateral compartments of the right leg, and therefore progressive muscle debridement was performed (Fig. 1, Fig. 2, Fig. 3).


Compartment syndrome after total knee arthroplasty: regarding a clinical case.

Pinheiro AA, Marques PM, Sá PM, Oliveira CF, da Silva BP, de Sousa CM - Rev Bras Ortop (2015)

Suturing of the fasciotomy sites was performed progressively and no skin grafts were necessary.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4563053&req=5

fig0015: Suturing of the fasciotomy sites was performed progressively and no skin grafts were necessary.
Mentions: On the second day after the operation, the patient presented as neurologically superposed, without any vestige of motor activity below the knee. This led to the suspicion of neuropraxia of the anterior and posterior tibial nerve, with motor alterations provoked by the garrote. A postoperative control X-ray of the right knee was normal. The patient was kept under observation. On the same day, due to persistence of the hypoesthesia, pain in the proximal region of the lower leg and marked tension on the lateral face of the lower leg, the hypothesis of compartment syndrome was put forward and urgent fasciotomy was proposed, with exploration of the external popliteal sciatic nerve. The latter was explored and the anterolateral compartment of the lower leg was released. During the immediate postoperative period, hypoperfusion of the right lower limb was observed and fasciectomy of the four compartments of the right leg was performed. The patient underwent urgent computed tomography angiography on the right lower limb, which had normal findings and did not show any vascular lesions or space-occupying lesions. The care taken with the bandaging of the fasciotomy sites showed that there was necrosis of the muscles of the anterior and lateral compartments of the right leg, and therefore progressive muscle debridement was performed (Fig. 1, Fig. 2, Fig. 3).

Bottom Line: Here, a clinical case of a patient who was followed up in orthopedic outpatient consultations due to right gonarthrosis is presented.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.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal.

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.

No MeSH data available.


Related in: MedlinePlus