Compartment syndrome of the calf following total knee arthroplasty—a case report of a highly unusual complication

In April 2005, an otherwise healthy 43-year-old woman presented at an external elective orthopedic unit with a more than 10-year history of effortrelated pain in the left knee. In her youth, she had been a hurdle runner at a competitive level. Preoperatively, there had been extensive discussions between the patient and her orthopedic surgeon because several arthroscopies and standard radiographical examinations had failed to demonstrate significant osteoarthritis, and no relevant deviation from the normal leg axis had been observed. Total knee arthroplasty was finally considered to be the appropriate solution for the patient’s knee pain, however, and the procedure was performed after regular preoperative investigations showing normal values of hemoglobin, sodium, potassium and prothrombin time-international normalized ratio (PTTINR), as well as normal blood pressure.

The procedure was performed under epidural anesthesia, which was continued postoperatively. A tourniquet was applied at 275 mm Hg for 65 min (equivalent to the total operating time) and the arthroplasty was carried out uneventfully through an anterior midline approach. The surgeon described degenerative changes in the lateral femoral condyle and in the lateral meniscus without further quantification, and concluded that there were few osteoarthritic changes. A cemented Freeman-Samuelson prosthesis (Zimmer Inc., Warsaw, IN) without patellar resurfacing was inserted. A lateral release was performed in order to achieve good patellar tracking; suction drains were not used. Peroperatively, the patient received 1 g cloxacillin i.v. three times, and 600 mg tranexamic acid intravenously. Anticoagulation started the evening before surgery by use of low molecular weight heparin (5,000 I.U. dalteparin subcutaneously).