A CASE REPORT SHOWING VASCULAR COMPLICATIONS IN COMPUTER GUIDED TOTAL KNEE ARTHROPLASTY

Abstract

Purpose of study: To report arterial injury related to reference pin placement in computer navigated knee arthroplasty.

Methods and results: Our practice is to use computer navigation for all primary total knee replacements (TKR). We use a passive reflector-based system (Brain-lab, Feldkirchen, Germany), with pin fixation of the reference arrays. For the femoral array two threaded pins are inserted anteriorly with the knee in flexion and are placed as proximally as the tourniquet will allow. The pins fixation is bicortical in order to maintain good stability for the duration of surgery.

A 58 year old man underwent TKR with computer navigation using our standard technique. His post operative course was characterized by thigh swelling and pain. He was discharged on postoperative day 3 with a range of movement of 0–30°.

3 days later he was readmitted with increasing thigh pain and swelling. A quadriceps haematoma was suspected and a computerized tomography scan with intravenous contrast was performed. This showed active bleeding into the femoral canal at the site of the pin tract from a branch of the profunda femoris artery as it entered the linea aspera and a large haematoma within the quadriceps muscle centred over the pin tract anteriorly. There was no extraosseous posterior haematoma.

An 800ml haematoma was drained and two small fragment cortical screws were inserted into the pin tracts. Unicortical screws were used to minimize the risk of causing posterior bleeding.

Arterial injury has not been reported before in this setting. The previously reported complications are: pin breakage, superficial wound infection, interference with line of sight, broken pelvic drill, prolonged operation time and prolonged tourniquet time.

Conclusion: This report highlights an important complication of computer navigated TKA which needs to be taken into consideration when deciding upon whether to use computer navigation.