Acute popliteal artery thrombosis after simultaneous bilateral total knee arthroplasty: a case report with long-term follow-up

Acute popliteal artery thrombosis is a rare but limb-threatening vascular complication after total knee arthroplasty. Delayed recognition and treatment can lead to irreversible limb ischemia or amputation. Previous reports have focused mainly on urgent revascularization, including open thrombectomy, bypass reconstruction, and endovascular intervention. However, clinical stratification, monitoring strategies, and long-term vascular outcomes remain insufficiently described for patients with early postoperative ischemia, preserved motor function, and no evidence of irreversible tissue injury. This case highlights the importance of early recognition, multidisciplinary assessment, individualized management, and long-term vascular outcomes in acute vascular complications after total knee arthroplasty. A 66-year-old woman developed pain, swelling, numbness, and decreased skin temperature below the left knee approximately 10 h after simultaneous bilateral total knee arthroplasty. Color Doppler ultrasonography and lower-extremity computed tomography angiography demonstrated acute thrombosis of the left popliteal artery with impaired distal arterial flow. Because active toe movement was preserved and there was no definite motor deficit, skin necrosis, or irreversible tissue injury, anticoagulation, vasodilator therapy, and systemic thrombolysis were administered under close vascular monitoring after joint assessment by orthopedic and vascular surgeons. Limb perfusion gradually recovered within 6 h, and limb salvage was achieved without open or endovascular revascularization. At the 36-month follow-up, knee range of motion was satisfactory, and color Doppler ultrasonography demonstrated patency of the left popliteal artery without obvious restenosis or recurrent thrombosis. This case emphasizes that unusually severe pain, numbness, decreased skin temperature, or weakening of distal pulses after total knee arthroplasty warrants prompt neurovascular assessment and vascular imaging. In patients with early-onset acute popliteal artery thrombosis, preserved motor function, and reversible ischemia, treatment decisions should be individualized according to the Rutherford classification, bleeding risk, distal perfusion, and availability of vascular surgery support and prompt rescue revascularization. The stable limb perfusion documented at the 36-month follow-up underscores the clinical importance of early recognition, multidisciplinary collaboration, dynamic monitoring, and long-term follow-up in managing this rare and potentially catastrophic complication.