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Hungerford M, Pichard‐encina CP, Boner A, Jones L. Measured distance from posterior tibia to popliteal artery increases with flexion and subluxation of the knee. J Exp Orthop 2024; 11:e12070. [PMID: 38957228 PMCID: PMC11217668 DOI: 10.1002/jeo2.12070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose Popliteal artery laceration is a devastating complication in total knee arthroplasty (TKA). Its anatomic position relative to the tibia has been studied using ultrasound or magnetic resonance imaging. This is the first study performed in a laboratory using radiographic measurements to determine if increased flexion and subluxation of the knee increase the distance between the tibia and popliteal artery. Methods The femoral artery was infused with radiopaque dye in six cadavers. The knee was placed in two different degrees of flexion and three of subluxation. The radiographic distance between standardized markers in the posterior tibia and popliteal artery was measured. Results The average distance from the tibial peg to the popliteal artery at 90° of flexion increased from 0% to 50% to 100% subluxation. The increase was statistically significant (Friedman test p = 0.016). The contrast between neutral and 100% subluxation was statistically significant (Sign test p = 0.031). At 115° flexion, average distance from the peg to popliteal artery significantly increased as subluxation increased (Friedman test p = 0.05). In three specimens, at 115° of flexion and 100% subluxation, a line perpendicular to the axis of the tibia, failed to intersect the popliteal artery. The measured distance increased from 90° to 115° of flexion at a given degree of subluxation, but this difference did not reach statistical significance. Conclusions Increasing flexion and subluxation of the tibia results in increasing distance between the cut plane of the tibial plateau and popliteal artery and decreases risk of laceration. Level of Evidence Not applicable.
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Affiliation(s)
- Marc Hungerford
- Orthopedics and Joint ReplacementMercy Medical CenterBaltimoreMarylandUSA
| | - Carmen P. Pichard‐encina
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Medstar Good Samaritan HospitalBaltimoreMarylandUSA
| | - Ashlie Boner
- Orthopedics and Joint ReplacementMercy Medical CenterBaltimoreMarylandUSA
| | - Lynne Jones
- Orthopaedic Surgery, Johns Hopkins University School of MedicineJohns Hopkins Bayview Medical CenterBaltimoreMarylandUSA
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2
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Mozaffar M, Sadighi M, Sabaghzadeh A, Biglari F, Kafiabadi MJ, Zolghadr A. Catastrophic case of the total knee arthroplasty dislocation: A case report. Int J Surg Case Rep 2024; 121:109925. [PMID: 38924922 DOI: 10.1016/j.ijscr.2024.109925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Arterial injury is extremely rare after total knee arthroplasty. CASE PRESENTATION We describe a 68-year-old woman with dislocation of total knee arthroplasty after falling from a height. She had a popliteal artery injury and a vascular bypass was performed in delay. The patient died of a second myocardial infarction 3.5 months after her first introduction to our center. CLINICAL DISCUSSION Due to the prominent risk of vascular injuries after dislocation in TKA patients, we recommend performing vascular evaluations using CT angiography for all patients. CONCLUSION Any untreated vascular compromise in the setting of TKA dislocation may lead to devastating outcomes such as amputation and death.
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Affiliation(s)
- Mohammad Mozaffar
- Department of General and Vascular Surgery, Shohada Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sadighi
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sabaghzadeh
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farsad Biglari
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meisam Jafari Kafiabadi
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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3
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Takei T, Kajiya T, Ninomiya T, Yamamoto K, Imamura K, Atsuchi N. Iatrogenic acute limb ischemia with complete traumatic rupture of the popliteal artery associated with total knee arthroplasty. J Cardiol Cases 2024; 29:193-196. [PMID: 38646080 PMCID: PMC11031660 DOI: 10.1016/j.jccase.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 04/23/2024] Open
Abstract
Acute limb ischemia (ALI) related to total knee arthroplasty (TKA) is rare. Most occlusions are caused by thrombus formation in the popliteal artery (PA). Currently such cases are revascularized using less invasive approaches such as endovascular therapy or Fogarty thrombectomy. We report a case of ALI in a 65-year-old woman with complete rupture of the PA due to a TKA procedure. She had resting pain and motor paralysis in her right lower extremity after TKA. Contrast-enhanced computed tomography showed occlusion of the right femoropopliteal artery. Subsequently, she was referred to our hospital with a diagnosis of ALI. Initially, a less invasive revascularization procedure was unsuccessfully attempted. Therefore, we performed an emergency distal bypass and succeeded in revascularization. Intraoperative examination revealed a complete rupture of the PA. Postoperatively, the patient exhibited no signs of myonephropathic metabolic syndrome. Although there was significant motor impairment, the affected limbs were successfully salvaged. ALI with complete rupture of the PA associated with TKA has not been reported previously. In cases of iatrogenic ALI after TKA, it would be essential to consider diagnostic and revascularization methods that account for the possibility of severe injury to the PA. Learning objective Acute limb ischemia after total knee arthroplasty is a rare and life- and limb-threatening condition. The underlying pathological mechanism is often thrombus occlusion due to mechanical stimuli of the popliteal artery (PA). There are no established treatments for this condition, and less invasive approaches such as endovascular procedures and Fogarty thrombectomy are often used. However, in cases involving severe damage to the PA, bypass surgery may be necessary, and revascularization procedures should be considered accordingly.
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Affiliation(s)
- Tatsuro Takei
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Takashi Kajiya
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Toshiko Ninomiya
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Keisuke Yamamoto
- Department of Cardiovascular Surgery, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Katsuyuki Imamura
- Department of Orthopedic Surgery, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Nobuhiko Atsuchi
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
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4
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Walker EA, Fox MG, Blankenbaker DG, French CN, Frick MA, Hanna TN, Jawetz ST, Onks C, Said N, Stensby JD, Beaman FD. ACR Appropriateness Criteria® Imaging After Total Knee Arthroplasty: 2023 Update. J Am Coll Radiol 2023; 20:S433-S454. [PMID: 38040463 DOI: 10.1016/j.jacr.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Total knee arthroplasty is the most commonly performed joint replacement procedure in the United States. This manuscript will discuss the recommended imaging modalities for six clinical variants; 1. follow-up of symptomatic or asymptomatic patients with a total knee arthroplasty. Initial imaging, 2. Suspected infection after total knee arthroplasty. Additional imaging following radiographs, 3. Pain after total knee arthroplasty. Infection excluded. Suspect aseptic loosening or osteolysis or instability. Additional imaging following radiographs, 4. Pain after total knee arthroplasty. Suspect periprosthetic or hardware fracture. Additional imaging following radiographs, 5. Pain after total knee arthroplasty. Measuring component rotation. Additional imaging following radiographs, and 6. Pain after total knee arthroplasty. Suspect periprosthetic soft-tissue abnormality unrelated to infection, including quadriceps or patellar tendinopathy. Additional imaging following radiographs. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | | | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cristy N French
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Tarek N Hanna
- Emory University, Atlanta, Georgia; Committee on Emergency Radiology-GSER
| | | | - Cayce Onks
- Penn State Health, Hershey, Pennsylvania, Primary care physician
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
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Diri D, Alasaad H, Abou Ali Mhana S, Muhammed H, Ibrahim J. Blood Loss in Primary Unilateral Total Knee Arthroplasty with Limited Tourniquet Application: A Randomized Controlled Trial. JB JS Open Access 2023; 8:e23.00020. [PMID: 38058509 PMCID: PMC10697626 DOI: 10.2106/jbjs.oa.23.00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Background Tourniquet application in total knee arthroplasty (TKA) has many benefits and may have a role in the incidence of perioperative complications. Our aims were to examine the safety of applying a tourniquet for a limited amount of time during primary unilateral TKA (specifically, during cementation and final component fixation only) and to compare perioperative complications between the limited-application group and the full-application group. Methods We conducted a randomized controlled study of 62 patients undergoing primary unilateral TKA. Patients were randomly allocated to either the limited or full tourniquet application. The follow-up period was 6 months. We evaluated intraoperative, postoperative, total, and hidden blood loss as the primary outcome measures and clearance of the surgical field, operative duration, and perioperative complications as the secondary outcome measures. Results We found a significant difference in surgical field clearance between the groups. There was no significant difference in total, hidden, or postoperative blood loss between the groups. Mean intraoperative blood loss was significantly lower in the full-application group than in the limited-application group (171.742 ± 19.710 versus 226.258 ± 50.290 mL; p = 0.001). Perioperative complications, including allogeneic blood transfusion rates, did not significantly differ between the groups. Conclusions Limited tourniquet application is safe to use in primary unilateral TKA and does not increase the incidence of perioperative complications or total blood loss when compared with a standard, full-time tourniquet application. Level of Evidence Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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6
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Wang C, Zhang X, Yu H, Cheng W. [Akute arterielle Embolie nach einer Knie-Totalendoprothese: Ein Bericht über zwei Fälle und Literaturübersicht]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:447-453. [PMID: 35158392 PMCID: PMC10648756 DOI: 10.1055/a-1714-9483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
Die akute arterielle Embolie ist eine seltene, aber schwerwiegende Komplikation nach einer Knie-Totalendoprothese (Knie-TEP). Es besteht ein allgemeiner Konsens darüber, dass in dieser Situation sofort eine Revaskularisation durchgeführt werden muss, aber die spezifische Behandlung ist immer noch umstritten. Wir berichten über zwei Fälle von Embolien der Kniekehlenarterie, die durch eine akute arterielle Thrombose nach Knie-TEP verursacht wurden. Bei beiden Patienten kam es nach der Operation zu einem Gefühls- und Bewegungsverlust der rechten unteren Extremität und einer Pulsationsschwächung der Arteria dorsalis pedis; eine Angiografie zeigte eine Embolie der Arteria poplitea. Einer der Patienten erhielt eine Thrombolysetherapie, entwickelte jedoch eine großflächige Infektion und Nekrose des rechten Wadenmuskels und benötigte nach erfolgreicher Thrombolyse ein mehrfaches Debridement und Hauttransplantationen. Bei dem anderen Patienten wurde eine Thrombektomie, eine Gefäßrekonstruktion und eine prophylaktische Fasziotomie durchgeführt; nach der Operation blieben ein Taubheitsgefühl im Fuß und eine leichte Streckschwäche zurück. Die Autoren empfehlen Chirurgen, Hochrisikopatienten mit Knie-TEP eine angemessene Aufmerksamkeit zu widmen. Vor der Operation sind eine sorgfältige Anamnese und körperliche Untersuchung erforderlich. Der chirurgische Eingriff sollte präzise und schonend durchgeführt werden, nach der Operation sind das Gefühl der Gliedmaßen und die Blutzirkulation aufmerksam zu beobachten. Bei abnormalem Fußgefühl und schwacher arterieller Pulsation sollten umgehend erforderliche Untersuchungen (Doppler-Ultraschall und Arteriografie) durchgeführt werden. Wenn eine arterielle Thrombose diagnostiziert wurde, muss die Blutversorgung sofort wiederhergestellt werden. Verzögert sich die Diagnose um mehr als 6 Stunden, kann eine prophylaktische Fasziotomie erforderlich sein, um nachteilige Folgen zu vermeiden.
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Affiliation(s)
- Chen Wang
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
- Second Clinical Medical College, Anhui Medical University, Hefei, China
| | - Xin Zhang
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
| | - Haoran Yu
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
| | - Wendan Cheng
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
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7
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Hamahashi K, Mitani G, Takagaki T, Sogo Y, Sato M, Watanabe M. Analysis of the running position of the popliteal artery and branching level of the anterior tibial artery detected by magnetic resonance imaging to avoid vessel injury during surgery around the knee joint. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 30:9-13. [PMID: 36090184 PMCID: PMC9417958 DOI: 10.1016/j.asmart.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/17/2022] [Accepted: 07/08/2022] [Indexed: 11/27/2022] Open
Abstract
Background Vessel injuries during total knee arthroplasty or high tibial osteotomy are rare but have serious complications. This study aimed to analyze the running position of the popliteal artery (PA) and branching level of the anterior tibial artery (ATA), using magnetic resonance imaging (MRI). This analysis might be helpful in avoiding unnecessary vessel injury. Methods In total, 105 patients (41 men and 64 women), whose running position of the PA and branching level of the ATA could be detected by preoperative MRI, were included in this study. We configured zones A, B, C, and D to be 5–10, 15–20, 25–30 and 35–40 mm distal from the lateral tibial plateau in the axial view, respectively. First, the distance between the posterior cortex of the tibia and anterior border of the PA was measured. Second, the PA position from the medial border of the tibia was measured. This measured value was divided by the transverse diameter of the tibia, and multiplied by 100 to obtain the PA position from the medial border of the tibia. Third, the branching level of ATA was measured from the joint line. Subsequently, each value was compared between men (the M group) and women (the W group). Results The distance between the posterior cortex of the tibia and the anterior border of the PA was 5.5 ± 1.9, 10.4 ± 2.4, 12.5 ± 2.3 and 12.5 ± 2.3 (mm; mean ± SD) in zones A, B, C, and D, respectively. Comparing both groups, this distance was significantly larger (more separated posteriorly) in zones C and D in the M group. The PA position from the medial border of the tibia was 51.7 ± 6.5, 52.7 ± 8.2, 56.7 ± 10.5 and 66.8 ± 14 (%; mean ± SD) in zones A, B, C, and D, respectively. On comparing the two groups, this position was significantly larger (more laterally shifted) in zone D in the W group. The branching level of the ATA was not detected within 40 mm distal to the joint line in 92 patients (87.6%). However, it was detected within 40 mm (mean 32.5 mm; range 20–38) in 12 patients (11.4%). Among them, 11 were women. Only one woman had an aberrant branching pattern: the ATA bifurcated at the joint level. Conclusion The PA positioned closest at the joint level, gradually separated and shifted laterally towards the distal side. The distance between the posterior cortex of the tibia and the anterior border of the PA was closer in women than in men in zones C and D. Although a difference of 2 mm is small, the risk of PA injury can be considered to be higher in women than in men. Furthermore, ATA injury is also a concern during retraction of the tibialis anterior muscle posteriorly, and the descending cut of the tibial tuberosity, particularly in women.
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8
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Sershon RA, Fricka KB, Hamilton WG, Nam D, Parks NL, DeBenedetti A, Della Valle CJ. Early Results of a Randomized Controlled Trial of Partial Versus Total Knee Arthroplasty. J Arthroplasty 2022; 37:S94-S97. [PMID: 35227810 DOI: 10.1016/j.arth.2022.02.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Debate still exists regarding the benefits of unicompartmental (UKA) versus total knee arthroplasty (TKA) for the treatment of medial compartment osteoarthritis. The purpose of this randomized trial is to compare the early outcomes of UKA versus TKA. METHODS One-hundred and seven candidates for UKA were randomized at two centers; 57 candidates received UKA and 50 received TKA. Six-week and 6-month outcome measures including Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR), Knee Society Score (KSS), Forgotten Joint Score (FJS), and VR-12 global health scores were obtained. No demographic or baseline patient reported outcome (PRO) differences were present suggesting successful randomization (P > .05). RESULTS UKA demonstrated shorter operative times (UKA = 65 minutes, TKA = 74 minutes; P < .001) and length of stay (UKA = 0.7 nights, TKA = 1.2 nights; P < .01). At 6 weeks, there were no differences in KOOS, JR (P = .755), KSS (P = .754), FJS (P = .664), or PRO change from preoperative scores (P = .468). There were three surgical complications within 90 days in each group. The duration of opioid consumption (UKA = 33.8 days, TKA = 28.5 days; P = .290) and return to work (UKA = 57.1 days, TKA = 47.3 days; P = .346) did not differ between groups. CONCLUSION Data suggest no clinically significant differences between UKA and TKA in the early postoperative period in regards to patient-reported outcome measures, duration of opioid use, or return to work. Patients undergoing UKA can anticipate a shorter length of stay and greater early range of motion. All-cause short-term complications may be more prevalent with TKA.
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Affiliation(s)
| | - Kevin B Fricka
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | | | - Dennis Nam
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | - Nancy L Parks
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
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Dabas A, Katiyar A, Srivastava S, Chadha A, Janardhanapillai R, Bhat K, Chadha D. A single-center 5-year experience of iatrogenic vascular injuries and their outcomes. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Schermer BA, Berger AC, Stomp W, van der Lugt JCT. Pseudoaneurysm of the Popliteal Artery After (Revision) Knee Arthroplasty. Arthroplast Today 2021; 13:1-6. [PMID: 34926745 PMCID: PMC8649579 DOI: 10.1016/j.artd.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/03/2022] Open
Abstract
Pseudoaneurysm of the popliteal artery is a rare complication of total knee arthroplasty (TKA), with a reported incidence of 0.0095% to 0.088%. We describe the case of a 66-year-old female who underwent conversion of unicompartmental knee arthroplasty (2014) to a TKA because of instability symptoms. A pseudoaneurysm of the popliteal artery was found postoperatively on ultrasound performed because of persistent symptoms of pain and tightness of her calf and hypesthesia of digits 3 to 5. She was treated endovascularly with placement of a covered stent. At the most recent follow-up (8 months after surgery), the complaints of hypesthesia persist. A pseudoaneurysm of the popliteal artery is a rare, yet well-described, complication of TKA often found coincidentally on Duplex ultrasound usually performed to rule out a deep venous thrombosis. Prompt diagnosis is of great importance given the potential to developing compartment syndrome or irreversible neurological deficits.
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Affiliation(s)
- Biko A Schermer
- Department of Orthopaedics, Reinier Haga Orthopedic Center, Zoetermeer, the Netherlands
| | - Arne C Berger
- Department of Orthopaedics, Reinier Haga Orthopedic Center, Zoetermeer, the Netherlands.,Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Wouter Stomp
- Department of Radiology, LangeLand Hospital, Zoetermeer, the Netherlands.,Department of Radiology, Haga Hospital, The Hague, the Netherlands
| | - Joris C T van der Lugt
- Department of Orthopaedics, Reinier Haga Orthopedic Center, Zoetermeer, the Netherlands.,Department of Orthopaedics, Haga Hospital, The Hague, the Netherlands
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11
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Athanasiou V, Panagopoulos A, Gliatis J, Papathanasiou N, Tyllianakis M, Megas P. Neglected Posterior Dislocation Septic Loosening and Prolonged Flexion Contracture of Total Knee Arthroplasty: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931857. [PMID: 34648481 PMCID: PMC8525905 DOI: 10.12659/ajcr.931857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Male, 62-year-old
Final Diagnosis: Arthroplasty • knee • posterior dislocation • prolonged flection contracture • septic loosening
Symptoms: Knee joint pain
Medication: —
Clinical Procedure: —
Specialty: Orthopedics and Traumatology
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Affiliation(s)
| | | | - John Gliatis
- Department of Orthopaedic, Patras University Hospital, Patra, Greece
| | | | - Minos Tyllianakis
- Department of Orthopaedic, Patras University Hospital, Patra, Greece
| | - Panagiotis Megas
- Department of Orthopaedics, Patras University Hospital, Patra, Greece
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12
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Kalmykov EL, Gaibov AD, Nematzoda O, Sharipov MA, Baratov AK. [Some aspects of iatrogenic vessel injury]. Khirurgiia (Mosk) 2021:85-91. [PMID: 33759475 DOI: 10.17116/hirurgia202104185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Iatrogenic events made up 1-10% of in-hospital mortality. Currently, iatrogenic vascular injuries are described for almost all surgical areas. Incidence of iatrogenic vascular injuries is gradually increased that is primarily associated with high number of percutaneous endovascular interventions. Surgical treatment of patients with iatrogenic vessel injuries is extremely difficult. This is due to sudden development of this complication, severe clinical state of the patient associated with underlying disease, acute massive blood loss, as well as insufficient experience of surgeon in urgent vascular surgery. Simple lateral or circular suturing is not always possible to restore the vessel integrity. Vascular replacement including non-standard vascular reconstructions are often required. Prevention of iatrogenic vascular injuries is also insufficiently described in the literature. Most manuscripts devoted to iatrogenic vascular injuries are usually represented by case reports or small sample. Thus, it is impossible to identify the main measures for prevention of iatrogenic injury.
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Affiliation(s)
| | - A D Gaibov
- Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - O Nematzoda
- Republican Research Center for Cardiovascular Surgery, Dushanbe, Tajikistan
| | - M A Sharipov
- Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - A K Baratov
- Republican Research Center for Cardiovascular Surgery, Dushanbe, Tajikistan
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