Vascular Injury during Total Knee Replacement and Check List to Follow in its Management: Case Report

Vascular injury during total knee replacement (TKR) is a rare but potentially serious complication. Early recognition and prompt intervention are crucial for managing these injuries effectively. Interdisciplinary collaboration with a vascular surgeon is essential to optimize patient outcomes, minimizing the risk of limb loss and other long-term complications.

We present a case of a 68-year-old woman with bilateral knee osteoarthritis who underwent bilateral TKR in a single surgical session with the right knee being the first knee. During left knee replacement, pulsatile bleeding was observed behind the femoral notch, following tourniquet deflation. Hemostasis was achieved and the procedure was completed. The patient's oxygen saturation in the left lower limb decreased postoperatively. Computed tomography angiography revealed a 4.5 cm long thrombus in the popliteal artery at the knee joint level with adequate distal runoff. Digital subtraction angiography confirmed the blockage again with collateral vessel refilling. A decision was made to undertake an exploration to address the blockage, aiming to prevent further extension of the thrombus to the bifurcation of the popliteal artery. Surgical exploration revealed a laceration and thrombus in the popliteal artery, thrombectomy was done with Fogarty which was followed by end-to-end repair. The patient's post-operative course was closely monitored. The patient went on to have a successful outcome and recovered well.

This case highlights the importance of early recognition, careful patient assessment, and immediate communication with an interventional radiologist and vascular surgeon in patients with suspected vascular injury during TKR. Interdisciplinary collaboration among orthopedic surgeons, interventional radiologists, and vascular surgeons is essential for optimizing patient outcomes in such cases.