Injury to the popliteal artery following primary Total Knee Replacement (TKR) is rare but has far reaching consequences to both the patient and the surgeon. It is a limb threatening event and can lead to amputation if prompt and adequate intervention is not undertaken. It is a traumatizing event to both the patient and the surgeon. We present a case of popliteal artery injury following primary total knee replacement. The diagnosis was made in the immediate post-operative period following increasing calf pain which was not responsive to analgesia and absent dorsalis pedis pulsation. This was confirmed with a Computerized Tomography (CT) angiography of the lower limb. The patient had immediate vascular exploration and a perforation was noted on the anterior wall of the popliteal artery. There was direct repair of the perforation and the intra-luminal arteriotomy repaired with a venous patch. There was spontaneous return of distal pulsation and the limb was salvaged. On follow up at 3 months, there were no ischaemic changes on the limb. Injury to the popliteal artery may result from direct arterial injury. Preventive measures which include good and safe surgical techniques must be employed during TKR. Early diagnosis and prompt intervention are necessary to prevent complications.
