Compartment syndrome following total knee arthroplasty

Abstract

Compartment syndrome is a rare complication of total knee arthroplasty that requires early recognition and prompt decompression in order to prevent long-term disability. We have found only one previous case report in the literature. We present a series of seven cases from four hospitals and five surgeons. Six of the cases resulted in the loss of at least one compartment, and one resulted in amputation. Four of the cases resulted in legal action. We suggest that important risk factors contributing to the development of this condition include complex surgery, soft-tissue compromise, previous surgery, and possibly vascular disease. Delay in the diagnosis and hence delay in decompression was common in our series, and in five cases appeared to be related to the use of a postoperative epidural infusion for pain relief. The presence of associated neurological compromise may have also been a significant factor in the delay to diagnosis in two cases.

Compartment Syndrome, Femoral Nerve Lesion and Recurrent Haemarthrosis in one and the same Patient after Total Knee Arthroplasty

“…The compartment syndrome was the result of bleeding from a knee joint cyst. This has been reported previously to be one of the causes of compartment syndrome (Haggis et al, 2006). Bleeding did not occur directly in the anterior compartment, but compression of this compartment was probably indirect due to a haematoma in the flexor compartment with subsequent spontaneous compression of the popliteal vein.…”

“…Tang and Chiu were the first to describe occurrence of compartment syndrome of the calf after early postoperative dislocation of a TKA (Tang and Chiu, 2000). Haggis et al reported on 7 cases of compartment syndrome following TKA and identified risk factors for the development of a compartment syndrome (Haggis et al, 2006). These factors include: soft-tissue compromise, often related to previous surgery, injury or complex surgery and vascular compromise or intra-operative vascular injury.…”

Acute compartment syndrome: reducing the risk

“…Unfortunately, an inability to dorsiflex the foot may be wrongly attributed to an epidural. 10 After one or two days, it finally becomes apparent that the foot drop is due to muscle damage secondary to vascular insufficiency and not the effects of the regional anaesthetic. Unfortunately, irreversible muscle damage will have occurred by the time the diagnosis is finally made.…”

Compartment Syndrome of the Lower Extremity

“…Tornetta and French [23] in a prospective case control study examined the changes in compartmental pressure in the anterior compartment of the tibia in 58 acute [31][32][33][34] Total hip arthroplasty [8,16,35,36] Arthroscopy [37][38][39] Intensive use of muscles (exercise induced CS) [40][41][42][43][44][45] Post ischemic reperfusion [46,47] Anticoagulants [48][49][50] Diabetes mellitus [51][52][53] Hypothyroidism [54] Leukemia [55] Sickle cell anemia [56] Nephritic syndrome [57] Venous obstruction [58] Popliteal cysts [59] Burns [60][61][62][63][64] Snakebites [65,66] Cold [67] Externally applied pressure Tight casts, dressing [68,69] Lying on limb (lithotomy position) [70][71][72][73]…”