Early detection and nonsurgical management of popliteal artery thrombosis after high tibial osteotomy: two case reports.

Introduction and Importance: Popliteal artery thrombosis is a rare but potentially limb-threatening complication following high tibial osteotomy, with an incidence ranging between 0.05% and 1.7%. Early detection and appropriate management are crucial in preventing irreversible ischemic damage. Pulse oximetry, traditionally used for systemic oxygen monitoring, has emerged as a valuable tool for detecting peripheral vascular compromise. This report highlights two cases of peripheral artery thrombosis following medial opening wedge HTO, both managed nonsurgically. We emphasize the role of pulse oximetry waveform analysis as a valuable diagnostic adjunct in clinical decision-making. Case Presentation: Clinical Discussion: Pulse oximetry waveform analysis proved instrumental in both cases, detecting compromised perfusion even when SpO₂ values were normal. The dicrotic notch alteration served as an early indicator of vascular injury. These findings suggest that waveform analysis may offer higher sensitivity in early detection compared to SpO₂ readings alone. Conclusion: Pulse oximetry, particularly waveform analysis, is a practical and noninvasive tool for the early detection of vascular injury following HTO. Its routine use in the postoperative period could enable timely diagnosis and facilitate conservative management, potentially reducing the need for vascular surgical intervention.