Late-Diagnosed Arterial Thrombosis Mimicking Complex Regional Pain Syndrome After TKR in a Patient With CREST Syndrome

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Tomás L. Nicolino
Mariano Agustín Revah
Julián Costantini
Juan Félix Astoul Bonorino
Lisandro Carbó
Matías Costa Paz

Abstract

Arterial thrombosis after total knee replacement (TKR) is a rare complication; however, it can lead to disastrous consequences. We describe a case of an arterial occlusion after TKR in an 85-year-old female patient. Initially, the clinical presentation made us consider Raynaud (she had a history of CREST) and complex regional pain syndrome, which delayed the diagnosis for 2 weeks. Diagnosis and treatment were accomplished with angiography and the patient achieved a full recovery. The low frequency of this injury may make diagnosis a challenge for the surgeon. In this case, partial occlusion of the arteries avoided more serious complications.
 

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How to Cite
Nicolino , T. L., Revah, M. A., Costantini, J., Astoul Bonorino, J. F., Carbó, L., & Costa Paz, M. (2022). Late-Diagnosed Arterial Thrombosis Mimicking Complex Regional Pain Syndrome After TKR in a Patient With CREST Syndrome. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(1), 79-84. https://doi.org/10.15417/issn.1852-7434.2022.87.1.1397
Section
Case Presentations
Author Biographies

Tomás L. Nicolino , Arthroscopy and Knee Prosthesis Sector, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina

Arthroscopy and Knee Prosthesis Sector, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina

Mariano Agustín Revah, Arthroscopy and Knee Prosthesis Sector, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina

Arthroscopy and Knee Prosthesis Sector, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina

Julián Costantini, Arthroscopy and Knee Prosthesis Sector, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina

Arthroscopy and Knee Prosthesis Sector, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina

Juan Félix Astoul Bonorino, Arthroscopy and Knee Prosthesis Sector, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina

Arthroscopy and Knee Prosthesis Sector, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina

Lisandro Carbó, Arthroscopy and Knee Prosthesis Sector, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina

Arthroscopy and Knee Prosthesis Sector, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina

Matías Costa Paz, Arthroscopy and Knee Prosthesis Sector, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina

Arthroscopy and Knee Prosthesis Sector, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina

References

1. Abularrage CJ, Weiswasser JM, Dezee KJ, Slidell MB, Henderson WG, Sidawy AN. Predictors of lower extremity
arterial injury after total knee or total hip arthroplasty. J Vasc Surg 2008;47(4):803-7. https://doi.org/10.1016/j.jvs.2007.11.067

2. Calligaro KD, Dougherty MJ, Ryan S, Booth RE. Acute arterial complications associated with total hip and knee
arthroplasty. J Vasc Surg 2003;38(6):1170-7. https://doi.org/10.1016/s0741-5214(03)00918-2

3. Sharma H, Singh GK, Cavanagh SP, Kay D. Pseudoaneurysm of the inferior medial geniculate artery following
primary total knee arthroplasty: delayed presentation with recurrent haemorrhagic episodes. Knee Surg Sports
Traumatol Arthrosc 2006;14(2):153-5. https://doi.org/10.1007/s00167-005-0639-4

4. Dennis DA, Neumann RD, Toma P, Rosenberg G, Mallory TH. Arteriovenous fistula with false aneurysm of the
inferior medial geniculate artery. Clin Orthop Relat Res 1987(222):255-60. PMID: 3621729

5. Youssef P, Englert H, Bertouch J. Large vessel occlusive disease associated with CREST syndrome and
scleroderma. Ann Rheum Dis 1993;52(6):464-6. https://doi.org/10.1136/ard.52.6.464

6. Dorevitch MI, Clemens LE, Webb JB. Lower limb amputation secondary to large vessel involvement in
sclerodermia. Br J Rheumatol 1988;27(5):403-6. https://doi.org/10.1093/rheumatology/27.5.403

7. Man A, Zhu Y, Zhang Y, Dubreuil M, Rho YH, Pelo-quin C, et al. The risk of cardiovascular disease in systemic
sclerosis: a population-based cohort study. Ann Rheum Dis 2013;72(7):1188-93. https://doi.org/10.1136/annrheumdis-2012-202007

8. Pal A, Clarke JMF, Cameron AEP. Case series and literature review: Popliteal artery injury following total knee
replacement. Int J Surg 2010;8(6):430-5. https://doi.org/10.1016/j.ijsu.2010.04.008

9. Bagla S, Rholl KS, van Breda A, Sterling KM, van Breda A. Geniculate artery embolization in the management of
spontaneous recurrent hemarthrosis of the knee: case series. J Vasc Interv Radiol 2013;24(3):439-42.
https://doi.org/10.1016/j.jvir.2012.11.011

10. Sadat U, Naik J, Verma P, See TC, Cousins C, Chitnavis JP, et al. Endovascular management of pseudoaneurysms following lower limb orthopedic surgery. Am J Orthop (Belle Mead NJ) 2008;37(5):E99-E102. PMID: 18587511