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Background and Aims We present a rare case of total knee arthroplasty in 32 year old down syndrome male patient, ASA 2, hypothyroidism presented with right knee pain scheduled for total knee arthroplasty under regional anesthesia.
Methods Pre anesthesia evaluation was assessed for airway management and best anesthesia plan according to his medical co-morbidities, blood results were within normal range. Cervical spine x-ray was requested. Thyroid function test revealed controlled treatment. His cardiac echo showed: The left ventricle is normal in size. There is normal left ventricular wall thickness. Left ventricular systolic function is normal. Ejection Fraction >55%. Left ventricular diastolic function is normal. The right ventricle is normal in size and function. Mildly thickened Aortic valve leaflet. Mild to moderate aortic regurgitation. His electrocardiogram showed normal sinus rhythm. Our plan for his total knee arthroplasty is under spinal anesthesia along with ultrasound guided adductor canal catheter and IPACK infiltration for postoperative pain control. The duration of surgery lasted for two hours without any complications and 300 ml estimated blood loss and adequate urine output.
Results He was receiving multimodal analgesia of adductor canal ropivacaine injection daily through the catheter, paracetamol IV, morphine 2 mg IV PRN, NSAIDS once daily. He was discharged home without any complications and he is doing back his daily activities without any chronic knee pain.
Conclusions As far as we know, this is the first case presentation of total knee arthroplasty in Down syndrome as it is common for hip arthroplasty than knee.
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