Arterial Injury in Total Knee Arthroplasty

Butt, Usman Shahid; Samuel, Rohit; Sahu, Ajay; Butt, Imran S.; Johnson, David S.; Turner, P.G.

doi:10.1016/j.arth.2010.05.018

Cited by 37 publications

(37 citation statements)

References 45 publications

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“…17,26 No patient in this study had previous vascular interventions performed to the actual limb, and there was no information suggesting severe peripheral arterial disease in any of them. Neither was there any routine pre-operative assessment of vascular status in any of the patients, and when analysing the mechanisms behind the injuries there is nothing that indicates that they could have been prevented by clinical preoperative vascular examination or duplex ultrasound.…”

Section: Discussionmentioning

confidence: 92%

“…Most injuries that were detected during the operation and repaired immediately had a good functional outcome, supporting the findings of previous studies. [7][8][9]15,17 Penetrating injury with bleeding and false aneurysm formation dominates PAIs in knee replacement. The use of a tourniquet does not seem play a role in the mechanism of injury.…”

Section: Discussionmentioning

confidence: 99%

“…Outcome in terms of functional impairment despite limb salvage has been barely investigated. 17 The primary aim of this study is to describe the mechanisms behind PAI during knee replacement. Secondary aims were to identify any risk factors, explore long-term outcomes and identify potential prevention strategies.…”

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confidence: 99%

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Popliteal artery injury during knee replacement

Bernhoff

Rudström

Gedeborg

et al. 2013

The Bone & Joint Journal

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Popliteal artery injury (PAI) is a feared complication during knee replacement. Our aim was to investigate those injuries that occurred in association with knee replacement in terms of the type of injury, treatment and outcomes. From our national vascular registry (Swedvasc) and the Swedish Patient Insurance databases a total of 32 cases were identified. Prospective data from the registries was supplemented with case-records, including long-term follow-up. We estimated the incidence during 1998 to 2010 to be 0.017%. In our series of 32 patients with PAI occurring between 1987 and 2011, 25 (78%) were due to penetrating trauma and seven were caused by blunt trauma. The patients presented in three ways: bleeding (14), ischaemia (7) and false aneurysm formation (11), and five occurred during revision surgery. A total of 12 injuries were detected intra-operatively, eight within 24 hours (3 to 24) and 12 at more than 24 hours post-operatively (2 to 90 days). Treatment comprised open surgery in 28 patients. Patency of the vascular repair at 30 days was 97% (31 of 32, one amputation). At the time of follow-up (median 546 days, mean 677 days (24 to 1251)), 25 patients had residual symptoms. Of seven patients with a complete recovery, six had had an early diagnosis of the PAI during the procedure, and were treated by a vascular surgeon in the same hospital. PAI is a rare adverse event during knee replacement surgery. The outcome following such events is often adversely affected by diagnostic and therapeutic delay. Bleeding and false aneurysm were the most common clinical presentations.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Popliteal artery injury during knee replacement

Bernhoff

Rudström

Gedeborg

et al. 2013

The Bone & Joint Journal

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“…Careful preoperative assessment should be performed, particularly in elderly or diabetic patients, who are at especially high risk. If necessary, vascular consultations should be performed before TKA, and the use of tourniquets during TKA should be carefully considered to prevent arterial complications [20]. Although the preoperative prevalence of DVT is very rare, orthopedic surgeons should consider modifiable risk factors of DVT and prophylactic medication after TKA.…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic peripheral vascular disease in total knee arthroplasty: preoperative prevalence and risk factors

Park

Lee

Park

et al. 2014

J Orthopaed Traumatol

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BackgroundAlthough vascular disease is commonly accepted as a risk factor for wound complications and prosthetic joint infections, little is known about the preoperative prevalence of lower-extremity peripheral vascular disease in patients undergoing total knee arthroplasty (TKA). In this study, we investigated the prevalence of asymptomatic vascular disease and its risk factors.Materials and methodsA total of 1,000 knees of 692 patients who underwent primary TKA due to osteoarthritis were preoperatively evaluated by experienced musculoskeletal radiologists using Doppler ultrasonography of the lower extremity vessels. The mean age of the patients was 74.1 years (range 65–81). Risk factors for development of peripheral vascular disease were investigated.ResultsAbnormal findings were identified in 38 knees of 32 patients (4.6 %); atherosclerotic changes in 31 knees of 25 patients (3.6 %), deep vein thrombosis (DVT) in two knees, and anomalous vessels in five knees. Three out of 31 knees with atherosclerotic changes showed severe luminal stenosis. Two knees were moderate and 26 knees showed mild changes according to our institutional criteria. Multivariate logistic regression analysis showed that age and diabetes mellitus were positively associated with vascular pathology.ConclusionThe prevalence of incidentally detected peripheral vascular disease was significant. Three of 31 knees had severe arterial stenosis and two knees had DVT. All patients with vascular pathologies had one or more risk factors related to vascular disease. Out of those patients, age was the most important risk factor. Understanding the prevalence of vascular pathology and related risk factors in TKA candidates may be important for successful TKA.Level of Evidence Level III.

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“…Such arterial complications include thrombosis, embolism, pseudoaneurysm, arteriovenous fistula, and arterial transection [2, 3]. These complications may occur intraoperatively, immediately postoperatively, or in the late postoperative period.…”

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confidence: 99%

Pseudoaneurysm of a high-division anterior tibial artery following primary TKA

Zhao

Liu

et al. 2017

Orthopäde

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Arterial complications following total knee arthroplasty are rare but carry a high risk of significant morbidity and mortality. Herein, the authors report a case of pseudoaneurysm in a branch of a high-division anterior tibial artery caused by laceration by the retractor following primary total knee arthroplasty in a 72-year-old woman. The patient presented with an unexplained hematoma and an enlarging swelling, with pallor and acute hemorrhage on the first postoperative day. The diagnosis was confirmed by arteriography and the patient was successfully treated using endovascular embolization without long-term complications. Because of the high risk of progression to a potentially limb- or life-threatening condition, it is important to discuss the risk factors for this complication, as well as its early diagnosis and treatment methods.Electronic supplementary materialThe online version of this article (doi: 10.1007/s00132-016-3373-3) contains two videos on diagnosis and treatment of the pseudoaneurysm. The article and the supplementary material are available in the electronic archive at http://www.springermedizin.de/der-orthopaede.

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Arterial Injury in Total Knee Arthroplasty

Cited by 37 publications

References 45 publications

Popliteal artery injury during knee replacement

Popliteal artery injury during knee replacement

Asymptomatic peripheral vascular disease in total knee arthroplasty: preoperative prevalence and risk factors

Pseudoaneurysm of a high-division anterior tibial artery following primary TKA

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