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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 3, 331-334.
doi: 10.1302/0301-620X.88B3.16919  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Compartment syndrome following total knee arthroplasty

A REPORT OF SEVEN CASES

P. Haggis, MBBS, BSc(Hons), Preregistration House Officer1; P. Yates, BSc(Hons), FRCS(Orth & Tr), Honorary Clinical Lecturer2; C. Blakeway, FRCS, Consultant Orthopaedic Surgeon3; D. Fick, MBBS(Hons), Honorary Clinical Lecturer4; D. A. F. Morgan, FRCS Ed(Orth), FRACS, Consultant Orthopaedic Surgeon5; M. Holt, FRACS, Consultant Orthopaedic Surgeon4; and D. Wood, MS, FRACS, Professor of Orthopaedics2

1 Whittington Hospital, Highgate Hill, London N19 5NF, UK.
2 Perth Orthopaedic Institute, Gate 3, Hollywood Private Hospital, Verdun Street, Nedlands, Western Australia 6009, Australia.
3 Royal Bournemouth Hospital, Castle Lane East, Bournemouth, Dorset BH7 7DW, UK.
4 Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia.
5 Holy Spirit Hospital, 259 Wickham Terrace, Brisbane, Queensland 4000, Australia.

Correspondence should be sent to Dr P. Haggis at 29 King’s Avenue, Eastbourne, East Sussex BN21 2PE, UK; e-mail: p.haggis{at}gmail.com

Compartment syndrome is a rare complication of total knee arthroplasty that requires early recognition and prompt decompression in order to prevent long-term disability. We have found only one previous case report in the literature. We present a series of seven cases from four hospitals and five surgeons. Six of the cases resulted in the loss of at least one compartment, and one resulted in amputation. Four of the cases resulted in legal action.

We suggest that important risk factors contributing to the development of this condition include complex surgery, soft-tissue compromise, previous surgery, and possibly vascular disease. Delay in the diagnosis and hence delay in decompression was common in our series, and in five cases appeared to be related to the use of a postoperative epidural infusion for pain relief. The presence of associated neurological compromise may have also been a significant factor in the delay to diagnosis in two cases.






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Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General