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Case report
Beware of the hot swollen calf following knee replacement surgery: it might not be a deep vein thrombosis
  1. Benedict Lotz1,
  2. Antony Palmer2 and
  3. Sunny D Deo3
  1. 1Orthopedics and Traumatology and Paraplegiology, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
  2. 2Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  3. 3Trauma and Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
  1. Correspondence to Mr Sunny D Deo; s.deo{at}


We report the case of a 77-year-old woman who presented with a 10-day history of increasing swelling and erythema of her right calf and popliteal areas 12 years after bilateral total knee replacements. Deep venous thrombosis (DVT), cellulitis or possible deep sepsis as a result of the knee replacement were the initial differential diagnoses. Due to clinical deterioration, exploration and radical debridement were performed and a 1.5 L collection of pus was identified through a small posteromedial proximal tibial bone defect adjacent to the tibial component, extending between gastrocnemius, soleus and into the distal calf. The procedure was extended to a first stage revision (complete implant and cement removal). Although leg swelling is common in joint infections secondary to knee swelling as a result of the inflammation, synovitis and/or knee effusion response, this case highlights the need to consider additional pathology such as deep abscess formation or DVT in these types of presentations.

  • venous thromboembolism
  • bone and joint infections
  • orthopaedics
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  • Contributors The study was designed by SDD and AP. BL contributed to the analysis as well as the interpretation of the data. All three authors contributed to the drafting and revision of the work and the final approval of the published version. Clinical case presentation and management undertaken at The Great Western Hospital, Swindon, UK

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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