Perioperative considerations for total knee arthroplasty in a patient with situs inversus totalis: a case report

Situs inversus totalis is a rare congenital condition characterized by complete mirror-image transposition of the thoracic and abdominal organs. Although situs inversus totalis is commonly discussed in cardiothoracic and abdominal surgery, its implications for orthopedic procedures, such as total knee arthroplasty, remain poorly described.

A woman in her late 60s presented with progressive right knee pain due to degenerative joint disease. Computed tomography incidentally revealed situs inversus totalis. Following multidisciplinary evaluation, a right total knee arthroplasty was performed under general anesthesia using standard surgical techniques without modification. The intraoperative and postoperative courses were uneventful, and the patient achieved satisfactory functional recovery at 1-year follow-up.

This case demonstrates that situs inversus totalis does not alter knee anatomy or the technical execution of total knee arthroplasty. However, reversed visceral and cardiac laterality may complicate perioperative cardiopulmonary assessment and monitoring if unrecognized. The primary value of this report lies in highlighting situs inversus totalis as a perioperative risk modifier rather than a surgical contraindication.

Total knee arthroplasty can be safely performed in patients with situs inversus totalis using standard techniques. Heightened perioperative awareness and structured team communication are essential to minimize avoidable risk and ensure patient safety during routine orthopedic procedures.