Compartment Syndrome Following Total Knee Arthroplasty: Clinical Results of Late Fasciotomy

Abstract

Compartment syndrome after total knee arthroplasty (TKA) is a rare complication. Because of its rarity, it may be overlooked and misdiagnosed as peroneal nerve palsy or deep vein thrombosis. This misdiagnosis could have a profound impact on the patient's outcome. We report a case of a 77-year-old female who developed unilateral compartment syndrome in the calf after staged bilateral TKA at an outside clinic. The patient presented with medical complications related to compartment syndrome: rhabdomyolysis and myoglobinuria, which caused acute renal failure. Thus, we performed late fasciotomy one week after symptom onset to debride necrotic tissue and salvage the compartment. In the discussion section, we will discuss risk factors for compartment syndrome after TKA, results of late fasciotomy and other indications for surgical treatment of compartment syndrome.

Ischemic Contracture following Compartment Syndrome Diagnosed 16 Months after Total Knee Arthroplasty: A Case Report and Review of the Literature

“…Compartment syndrome following TKA is rare and may be overlooked [3]. Signs and symptoms similar to traumatic causes can be seen in atraumatic cases, yet these symptoms are sometimes misattributed to postoperative pain and swelling, peroneal nerve palsy, or deep vein thrombosis [3, 4]. This can delay postoperative compartment syndrome diagnosis by up to 13 hours after symptom onset [17], which can lead to irreversible ischemic changes.…”

“…Compartment syndrome following elective total knee arthroplasty (TKA) is rare, primarily reported in case reports and small series. The length of time from TKA to the development of symptoms has been reported to range from hours to 1 week [3]. Compartment syndrome following TKA is frequently misdiagnosed as deep vein thrombosis, peroneal nerve palsy, or postoperative swelling [3, 4].…”

“…The length of time from TKA to the development of symptoms has been reported to range from hours to 1 week [3]. Compartment syndrome following TKA is frequently misdiagnosed as deep vein thrombosis, peroneal nerve palsy, or postoperative swelling [3, 4]. Postoperative analgesia may delay diagnosis, as it can mask clinical symptoms [3, 4].…”

“…Compartment syndrome following TKA is frequently misdiagnosed as deep vein thrombosis, peroneal nerve palsy, or postoperative swelling [3,4]. Postoperative analgesia may delay diagnosis, as it can mask clinical symptoms [3,4].…”

Acute Compartment Syndrome of the Lower Leg Using Navigated Endoprosthesis of the Knee

“…Für die Entstehung eines Kompartmentsyndroms sind u. a. folgende Risikofaktoren bekannt: ▪ Blutdruckmanschette > 3 h gesperrt ▪ spontane Einblutungen bei Gerinnungsstörungen oder Antikoagulanzientherapie ▪ venöse Insuffizienz (intraoperative iatrogene Gefäßverletzung, Thrombose, präoperativ bestehende höhergradige Durchblutungsstörung) [1,3] ▶ Abb. 3 Nach Dermatofasziotomie; VAC-Verband lateraler Unterschenkel.…”