Extensive subcutaneous emphysema of the thigh as a rare complication following total knee arthroplasty: A case report

INTRODUCTION AND IMPORTANCE OF THE CASE: This is the first report of subcutaneous emphysema of the thigh as a complication after total knee arthroplasty (TKA). PRESENTATION OF CASE: A 78-year-old female patient with valgus knee arthropathy underwent TKA. Two days postoperatively, the patient experienced left thigh swelling and pain, and subcutaneous emphysema was detected upon palpation. Although the skin tone was comparable to the other side, the left thigh was tender and firm. The surgical wound did not exhibit erythema. Computed tomography imaging revealed emphysema in the subcutaneous and intermuscular regions of the left thigh. Gram stain and culture tests from arthrocentesis were negative, and blood culture results were also negative. As there was no fever or disturbance of consciousness, and the LRINEC score was 1, supportive care was provided to the patient. At 5 days postoperatively, there was an observable improvement in the emphysema, and by day 9 postoperatively, the emphysema had fully resolved. CLINICAL DISCUSSION: There is a lack of documented cases reporting extensive subcutaneous emphysema of the thigh following TKA, suggesting it to be an exceedingly rare complication. In this case, we conducted a thorough investigation to assess the potential association of infection. Subsequently, the symptoms were successfully alleviated with supportive care without antibiotics. CONCLUSION: The occurrence of subcutaneous emphysema in the thigh was identified as a postoperative complication following TKA. Blood tests, culture tests and LRINEC score can be valuable tools for differentiation.