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Open repair of intraoperative popliteal artery injury during total knee arthroplasty in a patient with severe hemophilia A: A case report and literature review.

ABSTRACT: Arterial injuries during total knee arthroplasty (TKA) though rare may occur. Hemophilia may further challenge the management of such injury.A 48-year-old male patient with severe hemophilia type A and stiff knee arthropathy underwent bilateral TKAs. Left popliteal artery injury was detected at the end of the left TKA.Urgent angiography confirmed the diagnosis of the left popliteal artery transection.With clotting factor VIII replacement treatment, open repair was performed by end-to-end vascular bypass with the autograft of the large saphenous vein. No anticoagulant and antiplatelet treatment was administered postoperatively. Doses of the factor VIII were decreased step by step postoperatively.Left lower limb was reperfused 4?hours after the onset of the ischemia. The patient recovered uneventfully. Postoperative Doppler examination showed the left popliteal artery remained patent.The hemophilia may endanger the patients to higher risk of arterial injury during TKA because of the severe deformity and fibrosis around knee joint. For the hemophilia patients, with rational coagulation factor replacement therapy, open repair with autograft was an effective revascularization procedure for artery injury.

SUBMITTER: Feng B

PROVIDER: S-EPMC5704885 | biostudies-other | 2017 Nov

REPOSITORIES: biostudies-other

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Open repair of intraoperative popliteal artery injury during total knee arthroplasty in a patient with severe hemophilia A: A case report and literature review.

Feng Bin B Xiao Ke K Shao Jiang J Fan Yu Y Weng Xisheng X

Medicine 20171101 46

<h4>Rationale</h4>Arterial injuries during total knee arthroplasty (TKA) though rare may occur. Hemophilia may further challenge the management of such injury.<h4>Patient concerns</h4>A 48-year-old male patient with severe hemophilia type A and stiff knee arthropathy underwent bilateral TKAs. Left popliteal artery injury was detected at the end of the left TKA.<h4>Diagnoses</h4>Urgent angiography confirmed the diagnosis of the left popliteal artery transection.<h4>Interventions</h4>With clotting ...[more]

PMID: 29145340

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Project description:PurposeCombination of regional anaesthesia technique that is most effective in analgesia and postoperative functional outcome with the fewest complications needs investigation. Interspace between the popliteal artery and the capsule of the posterior knee block (IPACK) has been introduced clinically. We evaluated the efficacy of IPACK in combination with other nerve blocks after total knee arthroplasty.MethodsData were obtained from PubMed, Cochrane Library, Web of Science, and Sciencedirect. Studies that compared outcomes using IPACK combined with other regional nerve blocks after total knee arthroplasty with other analgesic modalities and those which used pain scores or opioid consumption as primary or secondary outcomes were included.ResultsSeventeen articles (20 trials, 1652 patients) were included. IPACK supplementation significantly reduced rest pain scores after total knee arthroplasty at postoperative hours 8-12(95%CI - 0.85 [- 1.36, - 0.34], I2 = 94%, p = 0.001), postoperative day 1 (95% CI - 0.49 [- 0.85, - 0.14], I2 = 87%, p = 0.006), and postoperative day 2 (95% CI - 0.28 [- 0.51, -0.05], I2 = 72%, p = 0.02); there was no significant difference at postoperative day 3 or discharge (95% CI - 0.14 [- 0.33, 0.05], I2 = 0%, p = 0.14). Combination treatment resulted in reduced dynamic pain scores at postoperative hours 8-12 (95%CI - 0.52 [- 0.92, - 0.12], I2 = 86%, p = 0.01) and postoperative day 1(95% CI - 0.49 [- 0.87, - 0.11], I2 = 88%, p = 0.01). There was no difference between postoperative day 2(95% CI - 0.29 [- 0.63, 0.05], I2 = 80%, p = 0.09), postoperative day 3 or discharge (95% CI - 0.45 [- 0.92, 0.02], I2 = 83%, p = 0.06). In addition, it strongly reduced postoperative opioid consumption within 24 H (95% CI - 0.76 [- 1.13, - 0.39], I2 = 85%, p < 0.00001), 24-48 H (95% CI - 0.43 [- 0.85, - 0.01], I2 = 83%, p = 0.04), and total opioid use (95% CI - 0.64 [- 1.07, - 0.22], I2 = 86%, p = 0.003). Although IPACK supplementation improved timed up and go test and walking distance at postoperative day 2, there was no statistically significant difference at other time periods or obvious improvement in knee range of motion and quadriceps strength. IPACK block supplementation could shorten the length of stay (LOS) (95% CI - 0.40 [- 0.64, - 0.15], I2 = 70%, p = 0.001) and improve patient satisfaction (95% CI 0.43 [0.01, 0.84], I2 = 87%, p = 0.04).ConclusionBased on these results, IPACK supplementation, in addition to standard postoperative analgesia, can be used effectively and safely to relieve early postoperative pain after total knee arthroplasty.

Project description:BACKGROUND:Total knee arthroplasty (TKA) is the treatment option for patients with severe osteoarthritis (OA) of the knee whose symptoms are refractory to conservative management. Unfortunately, the level of patient dissatisfaction is high, reaching up to 25%. The reasons for this dissatisfaction are multifactorial, but bone-implant mismatch significantly increases the chance of pain and functional limitation. Sex-specific prosthesis designs have been developed to overcome this issue, but their use is still controversial. The primary objective of this study was to evaluate possible sex differences in the shape of the distal femur in patients with osteoarthritis. Secondary objectives were to investigate interpersonal variability of the distal femur and to determine the number of femoral implant sizes required to meet shape variations. METHODS AND FINDINGS:A cross-sectional observational study prospectively compared 294 knees of 293 patients with osteoarthritis according to sex (201 female/93 male). Six intraoperative measurements were performed on the distal femur (height and width of both lateral and medial condyles, total medial-lateral width of the femur, and intercondylar distance). Sex differences and interpersonal variability were analyzed by multiple linear regressions. Measurements were also correlated with patient height. An optimization analysis was used to estimate the number of femoral implant sizes required. There were significant sex differences in the distal femur, where men had higher values than women in all measurements. Great interpersonal variability was found. The height of the lateral condyle was correlated with patient height, but the correlation was not strong. Twenty-five femoral implant sizes were required to meet the shape variations in our sample. CONCLUSIONS:The shape of the distal femur in patients with osteoarthritis shows great interpersonal variability, with men showing significantly higher values than women. A total of 25 different implant sizes would be necessary to adequately meet the variations observed in our study population.

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Open repair of intraoperative popliteal artery injury during total knee arthroplasty in a patient with severe hemophilia A: A case report and literature review.

Publications

Open repair of intraoperative popliteal artery injury during total knee arthroplasty in a patient with severe hemophilia A: A case report and literature review.

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