![]() After an uneventful recovery, she was transferred to the ward to undergo rehabilitation. The patient returned to the recovery unit where an anteroposterior and lateral X-rays of her right knee were performed as per departmental protocol (Figure 1). Forty mgs of clexane (enoxaparin) was given on the day of surgery with the plan to continue for 4 wk. The tourniquet was released after the application of dressings. After all components were cemented into place, a thorough washout with normal saline was performed and the wound was closed in layers. Standard surgical techniques for intraoperative haemostasis were used. A midline skin incision and medial parapatellar approach were utilised to expose the knee joint. After elevation of the limb, a pneumatic tourniquet around the upper part of the thigh was inflated to a pressure of 300 mmHg. Patient had three doses of perioperative cefuroxime as per hospital antibiotic prophylaxis guidelines. The surgical procedure was performed as per the surgeon’s routine practice under a spinal/epidural anaesthetic. Radiographs taken pre-operatively showed tricompartmental osteoarthritis. There were no signs of neurological deficit or vascular compromise in the lower limbs. Her clinical examination confirmed tenderness over the medial and lateral knee compartments as well as the retropatellar region with a range of movement from 0-120 degrees of flexion. She was a housewife and lived alone, a previously heavy smoker but stopped one year prior to her presentation and drank alcohol occasionally. Past surgical history included epistaxis needing cautery, duodenal ulcer surgery and gastroscopy. The patient occasionally also used home oxygen therapy for COPD exacerbations. Her medications included spiriva18 mcg, uniphyllin 200 mg, ramipril 1.25 mg, folic acid 5 mg, amlodipine 10 mg, ipratropium 500 mcg, omeprazole 20 mg and salbutamol inhaler and she had no medication allergy. In May 2013, a 72-year-old white British lady with background of chronic obstructive pulmonary disease (COPD), hypertension, prior pulmonary embolism, oesophagitis and cataracts was admitted with a diagnosis of primary osteoarthritis for an elective right TKR. We hereby, present a case of a compartment syndrome which occurred following TKR surgery and discuss the potential factors which may have contributed to its development. When measured, an intracompartmental pressure of 30 mmHg and delta (differential) pressure of 30 mmHg or less are used as an indication for fasciotomy.ĭespite the relative scarcity in the incidence of compartment syndrome following total knee replacement (TKR), it remains an important complication which may potentially be limb as well as life threatening. ![]() A normal compartmental pressure reflects the capillary pressure of 0 to 8 mmHg. A manometer device attached to a needle is inserted into each compartment to provide a pressure reading. The increase in intracompartmental pressures can be measured using the Wick catheter technique or a handheld manometer. Paraesthesia and paralysis arise as a result of significant compartmental ischaemia, after which a full recovery becomes unlikely. These symptoms alongside palor, pulselessness, paraesthesia and paralysis are characteristic for compartment syndrome. Pain out of proportion and pain on passive stretching of the affected compartment have been described as the most reliable clinical indicators of compartment syndrome. Fractures, crush injuries, vascular injuries, prolonged tourniquet application, anticoagulation and deep-vein thrombosis have all been associated with compartment syndrome, with fractures and soft tissue injuries accounting for approximately 80% of all cases. Compartment syndrome is a serious condition that occurs due to elevation of interstitial pressure in closed fascial compartments resulting in microvascular compromise, myoneuronal function impairment and soft tissue necrosis. ![]()
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