False aneurysm of the popliteal artery: a rare complication of total knee replacement

Introduction: Prosthetic joint infection (PJI) is a rare complication of total knee replacement (TKR), yet it is a serious and debilitating condition. Bacterial infection accounts for the majority of cases and fungal infection is estimated to cause 1% of all prosthesis infection. Case Report: This case presents a 60years female, who presented to our outpatient orthopedic clinic complaining of right knee pain, swelling, and hotness. The physical examination revealed redness, hotness, restricted range of movement, and tibial loosening, 9 months following TKR revision. Culture of the joint aspirate showed growth of “Candida parapsilosis” and second aspirate confirmed the diagnosis. The patient then underwent two stages revision surgery with placement of amphotericin B loaded cement, to maintain high local antifungal concentration in addition to decrease the side effects of amphotericinB infusion such as thrombophlebitis and the more serious systemic effect as nephrotoxicity. The post-operative course was uneventful, with gradual improvement and restoration of normal movement range. Conclusion: Fungal PJI is a rare complication of TKR, yet it results in severe debilitating symptoms and impairment of the patient functional capacity. Careful evaluation of the patient followed by a detailed workup is necessary for the identification of the underlying causative micro-organism. Two-stage revision surgery with antifungal loaded cement spacer and antifungal therapy currently is the standard of management. To the best of our knowledge, this is the first fungal PJI following total knee arthroplasty reported in Jordan. Keywords: Fungal prosthetic joint infection, fungal infection, total knee replacement, total knee replacement complication.

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Popliteal Artery Pseudoaneurysm with Secondary Chronic Common Peroneal Nerve Neuropathy and Foot Drop after Total Knee Replacement

Annals of Vascular Surgery ◽

10.1016/j.avsg.2015.04.082 ◽

2015 ◽

Vol 29 (7) ◽

pp. 1453.e5-1453.e8 ◽

Cited By ~ 5

Author(s):

Christopher George Ghazala ◽

Tarek Afifi Elsaid ◽

Ahmed Mudawi

Keyword(s):

Total Knee Replacement ◽

Knee Replacement ◽

Popliteal Artery ◽

Peroneal Nerve ◽

Common Peroneal Nerve ◽

Foot Drop ◽

Artery Pseudoaneurysm ◽

Total Knee ◽

Popliteal Artery Pseudoaneurysm

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Popliteal artery pseudoaneurysm after total knee replacement

VASA ◽

10.1024/0301-1526.36.2.145 ◽

2007 ◽

Vol 36 (2) ◽

pp. 145-148 ◽

Cited By ~ 6

Author(s):

Papas ◽

Maltezos ◽

Papanas ◽

Antoniou ◽

Lazarides

Keyword(s):

Total Knee Replacement ◽

Knee Replacement ◽

Popliteal Artery ◽

Ankle Brachial Index ◽

Artery Aneurysm ◽

Left Knee ◽

Artery Pseudoaneurysm ◽

Popliteal Artery Aneurysm ◽

Vein Thrombosis ◽

Total Knee

We report the case of a popliteal pseudoaneurysm following total knee replacement. A 70-year-old woman underwent total left knee replacement because of severe osteoarthritis. Eight days later, she presented with oedema and pain in her left calf. She had palpable foot pulses on the left leg and the ankle-brachial index was 0.98. The patient was treated for deep vein thrombosis. Two days later her calf pain and oedema deteriorated and her distal pulses were no longer palpable, while she developed limb coldness and paraesthesia, and the ankle-brachial index dropped to 0.4. Sonography was urgently performed indicating a large popliteal artery aneurysm (5.8 × 6.9 × 7.2 cm), confirmed by angiography. The patient was managed with removal of a 3.5 cm long segment of the popliteal artery and reconstruction with synthetic graft (PTFE 6 mm). Her condition soon improved and the patient is capable of walking approximately 1 km per day at 18-month follow-up.

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The national incidence of iatrogenic popliteal artery injury during total knee replacement

Vascular ◽

10.1177/1708538114552464 ◽

2014 ◽

Vol 23 (5) ◽

pp. 455-458 ◽

Cited By ~ 9

Author(s):

Anahita Dua ◽

Reyna Zepeda ◽

Francisco C Hernanez ◽

Anthony A Igbadumhe ◽

Sapan S Desai

Keyword(s):

Total Knee Replacement ◽

Knee Replacement ◽

Popliteal Artery ◽

Primary Diagnosis ◽

Hospital Charges ◽

Hospital Inpatient ◽

Replacement Surgery ◽

Artery Injury ◽

National Characteristics ◽

Total Knee

Introduction The aim of this study was to characterize national characteristics of patients who have a total knee replacement complicated by popliteal artery injury by incidence and patient demographics. Methods All patients with ICD-9 confirmed total knee replacement who had an iatrogenic popliteal artery injury were included from the national in-patient sample from 1998 to 2011. Age, gender and race, procedure type, time to popliteal artery injury, limb outcome, length of stay and hospital inpatient charges were reported. Results A total of 1,297,369 patients underwent a total knee replacement of which 43 were complicated by popliteal artery injury (0.003%); 93% had osteoarthritis as their primary diagnosis. The mean age was 61.7 ± 12.3 years. In all, 96% of patients had their popliteal injuries detected intra-operatively or on the day of total knee replacement surgery. The majority of these patients either received stent placement (44%) or peripheral bypass (30%) as their treatment modality for popliteal artery injury. There were no amputations or deaths in this cohort. The median hospital charges for this group were $27,570 (2014 USD). Conclusion The national incidence of iatrogenic popliteal artery injury in patients undergoing TKR is 0.003%. There were no amputations in our study population and 96% of patients had their injury detected intra-operative or immediately post-operatively.

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