A Rare Presentation of Pseudoaneurysm of the Popliteal Artery After Total Knee Replacement: A Case Report and Review of the Literature

Total knee replacement (TKR) is a common successful surgery in terms of the outcomes. The common complications of TKR are joint infection, deep venous thrombosis (DVT), wound complication, and postoperative knee instability. Arterial complications are not common. We are presenting a 61-year-old man who underwent left TKR. Upon postoperative regular follow-up, the patient developed symptoms and clinical presentation for DVT. However, initial duplex ultrasonography was negative for DVT. Repeated duplex ultrasonography showed a pseudoaneurysm of the popliteal artery, and the diagnosis was confirmed with computed tomography (CT) angiography. Pseudoaneurysm of the popliteal artery is a rare complication following primary TKR. Our patient underwent endovascular angioplasty and stenting of the pseudoaneurysm of the left popliteal artery. The patient completed three years and six months of follow-up with an uneventful course. We selected to share our experience of this rare case because pseudoaneurysm of the popliteal artery is a rare complication after TKR, which is usually present with symptoms that can mimic DVT, such as acute lower limb swelling, calf muscle pain, and pain with passive ankle dorsiflexion. Duplex ultrasonography is the preferred first diagnostic tool, and CT angiography (CTA) is needed to confirm the diagnosis and to plan treatment. Treatment with endovascular stent proved to be safe and successful with no infection risk or need for modifying rehabilitation protocol after more than three years of follow-up.