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CC BY-NC-ND 4.0 · Z Orthop Unfall 2023; 161(04): 447-453
DOI: 10.1055/a-1714-9483
Case Report

Acute Arterial Embolization Following Total Knee Arthroplasty: A Report of Two Cases and Literature Review

Akute arterielle Embolie nach einer Knie-Totalendoprothese: Ein Bericht über zwei Fälle und Literaturübersicht
Chen Wang 
1   Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
2   Second Clinical Medical College, Anhui Medical University, Hefei, China (Ringgold ID: RIN12485)
,
Xin Zhang
3   Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
,
Haoran Yu
3   Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
,
Wendan Cheng
3   Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
› Author AffiliationsSupported by: Anhui Provincial Department of Science and Technology S202007d07050015.
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Abstract

Acute arterial embolization is a rare but serious complication following total knee arthroplasty (TKA). So far, the general consensus for this situation is that revascularization must be performed immediately, but the specific treatment is still controversial. We report two cases of popliteal artery (PA) embolization caused by acute arterial thrombosis following TKA. Both patients suffered the loss of sensation and movement of the right lower limb and disappearance of dorsalis pedis artery pulsation after operation. Angiography showed PA embolization. One of the patients received thrombolytic therapy, but he developed a large area of infection and necrosis of the right calf muscle and required multiple debridement and skin grafting procedures after successful thrombolysis. The other patient underwent thrombectomy, vascular reconstruction, and prophylactic fasciotomy, and some foot numbness and slight extensor weakness remained after the operation. The authors suggest that surgeons should pay adequate attention to high-risk patients with TKA. Medical history and physical examination should be carefully collected before operation. The surgical procedure should be performed accurately and gently, and limb sensation and blood circulation should be carefully observed after operation. If foot sensation is abnormal and arterial pulsation is weakened, necessary examinations (Doppler ultrasound and arteriography) should be carried out immediately. Once diagnosed with arterial thrombosis, the blood supply should be restored immediately. If the diagnosis is delayed for more than 6 hours, prophylactic fasciotomy may be required as a treatment to avoid adverse consequences.

Zusammenfassung

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.

Schlüsselwörter

Kniearthroplastik insgesamt - akute arterielle Thrombose - Thrombolyse - Thrombetomie - Bericht des Falles

Keywords

total knee arthroplasty - acute arterial thrombosis - thrombolysis - thrombectomy - case report


Publication History

Received: 01 August 2021

Accepted after revision: 03 November 2021

Article published online:
14 February 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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