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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

Two months after the operation, the patient was still undergoing physiotherapy and the deficits of dorsiflexion in the right foot remained, with swelling of the posterior muscles of the lower leg.
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fig0020: Two months after the operation, the patient was still undergoing physiotherapy and the deficits of dorsiflexion in the right foot remained, with swelling of the posterior muscles of the lower leg.

Mentions: On the day of hospital discharge, the patient continued to be asymptomatic in the right knee and presented mobility of 0–90°, without significant inflammatory signs. She did not present any extension strength in the ankle and toes, and had slight dorsiflexion in the ankle and second to fifth toes of the right foot. She reported having paresthesia on the lateral face of the lower leg and hypoesthesia on the heel, internal face of the foot and first and second toes of the right foot. Because she was walking with a hanging foot, an anti-equinus splint was prescribed. On the 40th postoperative day, the patient was walking with the aid of a frame and was using a splint. She was advised to undergo rehabilitation at a continuing care unit, with intensive physiotherapy. Two months after the operation, she was still having physiotherapy and continued to present a deficit of dorsiflexion in her right foot, with swelling of the posterior muscles of the lower leg, and was using a splint to stabilize her gait. She was being followed up as an orthopedics outpatient, with improvement of right-knee joint range of motion and walking with crutches (Fig. 4, Fig. 5).


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)

Two months after the operation, the patient was still undergoing physiotherapy and the deficits of dorsiflexion in the right foot remained, with swelling of the posterior muscles of the lower leg.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

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

fig0020: Two months after the operation, the patient was still undergoing physiotherapy and the deficits of dorsiflexion in the right foot remained, with swelling of the posterior muscles of the lower leg.
Mentions: On the day of hospital discharge, the patient continued to be asymptomatic in the right knee and presented mobility of 0–90°, without significant inflammatory signs. She did not present any extension strength in the ankle and toes, and had slight dorsiflexion in the ankle and second to fifth toes of the right foot. She reported having paresthesia on the lateral face of the lower leg and hypoesthesia on the heel, internal face of the foot and first and second toes of the right foot. Because she was walking with a hanging foot, an anti-equinus splint was prescribed. On the 40th postoperative day, the patient was walking with the aid of a frame and was using a splint. She was advised to undergo rehabilitation at a continuing care unit, with intensive physiotherapy. Two months after the operation, she was still having physiotherapy and continued to present a deficit of dorsiflexion in her right foot, with swelling of the posterior muscles of the lower leg, and was using a splint to stabilize her gait. She was being followed up as an orthopedics outpatient, with improvement of right-knee joint range of motion and walking with crutches (Fig. 4, Fig. 5).

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