Arterial occlusion after total knee arthroplasty despite minimal invasive technique in aneurysm at popliteal artery: Case report

RATIONALE: Arterial occlusion, a rare condition after total knee arthroplasty (TKA), may cause fatal outcomes if not treated on time. We report a case of arterial occlusion after undergoing navigated TKA with no tourniquet use, in a patient at high risk of postoperative arterial occlusion due to the patient's ipsilateral popliteal artery aneurysm. PATIENTS CONCERNS: A 79-year-old man presented with several years of left knee joint pain. Nine years earlier, the patient underwent vascular graft surgery on his right knee due to occlusion in his right popliteal artery. On physical examination, the patient showed antalgic gait due to the pain in his left knee. DIAGNOSIS: Preoperative examination for arterial blood flow demonstrated reduced blood flow of the patient's right dorsalis pedis and right posterior tibial artery, with ankle-brachial index of 0.41 and 0.41. The blood flow of the left dorsalis pedis and left posterior tibial artery remained normal, with ankle-brachial index of 1.16 and 1.10. Femoral artery computed tomography (CT) scan revealed left popliteal artery aneurysm with mural thrombus, with occlusion of the left anterior tibial artery (ATA). The left peroneal artery and posterior tibial artery remained patent. INTERVENTION: Total knee arthroplasty using navigation without the use of tourniquet. OUTCOMES: Occlusion of the posterior tibial artery trunk was revealed with Doppler ultrasound and femoral artery CT several hours postoperatively, and the patient underwent thromboembolectomy at the very next day. LESSONS: In patients at high risk of postoperative arterial occlusion, such as patients with arterial aneurysm with mural thrombus, arterial occlusion may occur despite surgical techniques with minimal damage to the vessels. We found out that diseases of the artery might be a contraindication for TKA, and when TKA may be performed in high-risk patients, close cooperation with a vascular surgeon is a must.