Compartment Syndrome Secondary to Intraosseous Access Abutting Tibial Stem Cement Mantle of a Total Knee Arthroplasty

Abstract

Case: A 79-year-old man 6 days status-post left total knee arthroplasty (TKA) presented to our institution from an outside hospital (OSH) after a suspected STEMI and ventricular fibrillation arrest. At the OSH, intraosseous (IO) access was placed in his right tibia. Orthopaedics was consulted for compartment syndrome at the IO access site. X-rays demonstrated this was secondary to the IO access abutting the cement mantle of a stemmed tibial component of a remote TKA, for which the patient required emergent fasciotomies.Conclusions: Healthcare providers should be cognizant of potential orthopaedic hardware that can impede proper introduction of IO access. Establishment of intraosseous (IO) access can be a potential life-saving measure but is not without risk. In this report, we present an unusual mechanism for IO access leading to compartment syndrome with improper placement of IO access about previous orthopaedic implants.Consent for this case report was obtained from the patient's power of attorney.