A bleeding pseudoaneurysm of the lateral genicular artery after total knee arthroplasty—A case report

Copyright © Taylor & Francis 2004. ISSN 0001–6470. Printed in Sweden – all rights reserved. DOI 10.1080/00016470510030463 A 64-year-old man with a history of hypertension, benign prostatic hypertrophy, chronic obstructive pulmonary disease and a dilated aorta had undergone total knee replacement of his left knee due to severe disabling osteoarthrosis. The preoperative physical examination revealed mild effusion, a varus deformity of 20 degrees, and a normal but painful range of motion and mediolateral instability of both knees. Laxity was present in his shoulder, elbow and wrist joints. Plain radiographs of the knees demonstrated advanced degenerative changes with severe narrowing of the medial joint spaces bilaterally. The left knee was chosen for surgery, since it was the more painful and disabling. A posterior stabilizer prosthesis was implanted and lateral release of the patellar retinaculum was carried out. There were no intraoperative complications and the alignment and stability of the prosthesis was satisfactory. The course during the first postoperative month was uneventful, except for a hematoma on the anterolateral side of the knee where the lateral release had been performed: the hematoma appeared one day postoperatively and gradually dissolved spontaneously. 4 weeks after surgery, the patient started to complain of increasing pain and gradual swelling of his operated knee. He presented to the emergency room due to agonizing knee pain 2 weeks later. His left knee was very swollen, especially on the anterolateral side. It was warm and tender and any passive or active motion aggravated the pain. The hemoglobin level was 7.8 mg/dL, the white blood count was 7.6 × 103/μL, the coagulation profile was normal and the sedimentation rate was 42 mm/ hr (the sedimentation rate before surgery being 41 mm/hr). The patient was admitted to the orthopedic department and arthroscopy was performed 2 days afterwards. The knee was lavaged and several blood clots were drained. No active bleeding was detected. Improvement in the pain and swelling lasted for 5 days. On the 6th day after the arthroscopy, the patient complained of an acute, sharp agonizing pain and a sudden worsening of the swelling of the operated knee. The findings of the physical examination were similar to those on the day of admission. The knee was again swollen and tender and the pain was aggravated by