Total knee arthroplasty in patients with peripheral vascular disease

Dakka, Mahmoud; Badri, Hamidreza; Al‐Khaffaf, Haytham

doi:10.1016/s1479-666x(09)80111-x

Cited by 22 publications

(11 citation statements)

References 13 publications

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“…An ankle brachial pressure index should be obtained in at‐risk patients, and an index < 0.9 should trigger a referral for vascular assessment and possible intervention before TKA. Intra‐operative tourniquet use is generally not recommended …”

Section: Optimising Pre‐operative Status To Maximise Recovery and Attmentioning

confidence: 99%

“…Intra-operative tourniquet use is generally not recommended. 113,114 Smoking Multiple studies confirm that smokers are at significantly higher risk of many complications and mortality following TKA. 115,116 Strategies to reduce or stop smoking should routinely be offered, as there are clear health benefits beyond those related to TKA.…”

Section: Peripheral Vascular Diseasementioning

confidence: 99%

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Selecting and optimising patients for total knee arthroplasty

Adie

Harris

Chuan

et al. 2019

Medical Journal of Australia

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Summary The minimum requirements for total knee arthroplasty (TKA) are significant, prolonged symptoms with supporting clinical and radiological signs. Despite interest in screening tools, there is limited evidence for a specific symptom threshold that justifies surgery. Non‐operative treatments including medications, exercise and weight loss are unlikely to reverse radiographic changes, but they may improve symptoms and delay the need for surgery. Many patient factors such as mental health and obesity affect both the level of symptomatic improvement after surgery and risks of surgery, but none have been identified as contraindications for the procedure as significant health gains can still be achieved. Although age and sex are associated with patient‐reported outcomes and risk of revision, these factors cannot be used to restrict access to TKA, and age cut‐offs are not recommended. Evidence regarding pre‐operative optimisation of patients to improve post‐operative TKA outcomes is limited by the few interventional trials available, particularly in the areas of patient expectation, diabetes, obesity and vascular disease. There is good evidence from randomised controlled trials that pre‐operative rehabilitation primarily focusing on exercises for the joint or limb has minimal effect on post‐operative TKA outcomes, and there is some evidence from randomised controlled trials that an intensive smoking cessation program before surgery may improve post‐operative outcomes. Detailed international guidelines exist on the optimisation of the cardiorespiratory status of surgical patients, and these should be followed for TKA surgery.

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Section: Optimising Pre‐operative Status To Maximise Recovery and Attmentioning

confidence: 99%

Section: Peripheral Vascular Diseasementioning

confidence: 99%

Selecting and optimising patients for total knee arthroplasty

Adie

Harris

Chuan

et al. 2019

Medical Journal of Australia

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“…Vascular complications after TKA are very rare in the general population (0.05%). [7,8] However, in case of circulatory disorders due to vascular pathologies, there are several risks which may be fatal, ranging from wound closure problems to acute ischemic stroke and pulmonary embolism. [9] Most patients with vascular complications after TKA are those had previous peripheral vascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, peripheral vascular evaluation is recommended in many centers before and after TKA. [8] The three main factors associated with VTE include positive VTE history, varicose veins, and congestive heart failure after hip or knee arthroplasty. [10] These three main reasons are the diseases which can give evidence with color DUS and are helpful to inform the surgeon in terms of the preoperative measures.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of arterial and venous abnormalities in asymptomatic patients undergoing total knee arthroplasty

Atilla¹

2019

Turk J Vasc Surg

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Objectives: This study aims to investigate the prevalence of venous and arterial diseases in asymptomatic patients undergoing total knee arthroplasty (TKA) and to evaluate possible surgery-related vascular complications. Patients and methods: The data of a total of 96 extremities of 48 vascular asymptomatic patients (9 males, 39 females; mean age 65.7±51.8 years; range, 50 to 85 years) who underwent arterial and venous bilateral Doppler ultrasound examination between October 2017 and February 2018 were retrospectively analyzed. Stenosis of the arterial and venous system thrombosis and venous insufficiency were recorded. Results: Although no significant vascular pathologies such as deep vein thrombosis or arterial occlusion were detected, minor vascular pathologies such as minimal atherosclerosis (29.2%) and venous reflux (25%) were found in patients scheduled for TKA. Conclusion: In most patients, TKA operations can be performed without a vascular comorbidity; however, even asymptomatic patients may carry vascular risks. These silent patients can be identified by simple non-invasive tests. Patients under risk are supposed to be consulted with vascular surgery before the operation and can be operated in the hospital setting where a vascular surgery unit is available. Recognizing the silent group with color Doppler ultrasound can be helpful and feasible in patients undergoing TKA to reduce complication rate and to take precautions.

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“…6,13 Patients compromised by peripheral vascular disease are more at risk of developing complications and should be evaluated preoperatively by a vascular surgeon. 20 It is reported that preoperative selection could reduce the risk of vascular lesions during surgery. 7,12 Others however report that no specific measures can be taken to prevent it.…”

Section: Discussionmentioning

confidence: 99%

Popliteal lesion due to traction during unicompartmental knee revision surgery

Kerens¹,

Boonen

Schotanus

et al. 2013

Journal of Orthopaedics

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a b s t r a c tPopliteal artery injury is a rare but known complication in knee surgery. Only one article in current literature reports that the risk increases during revision knee surgery. A new case is described in which an injury to the popliteal artery occurred during lateral unicompartmental to total knee arthroplasty revision surgery. This vascular injury occurred 5e10 cm below the tibial resection level in a healthy patient with a history of cruris fracture with plate osteosynthesis and lateral unicompartmental knee arthroplasty. This paper stresses the importance of being aware that trauma and surgery can create fibrosis in which the popliteal artery can get fixated, thus reducing the scope for safe manipulation of the knee during secondary surgery.Copyright ª 2013, Professor P K Surendran Memorial Education Foundation. Publishing Services by Reed Elsevier India Pvt. Ltd. All rights reserved. IntroductionVascular lesions of the popliteal artery are rare but have been described after total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), revision TKA, correction osteotomy procedures and dislocations of the knee. 1e9 Etiology can be thrombosis, direct trauma or indirect trauma. 3,6,7,10e16 Our case shows an indirect popliteal lesion 5 cm distal to the operation area in a patient during revision knee surgery and stresses the importance of meticulous surgery in order to prevent indirect trauma especially in cases in which fibrosis could be present due to prior surgery or trauma. Case reportA fifty one year old healthy female was treated for lateral compartmental osteoarthritis of the right knee in another hospital. A lateral UKA was performed. Because of complaints on the lateral side of the knee she visited us two years after primary surgery. The diagnosis of tibial component overhang was made and revision surgery was planned. j o u r n a l o f o r t h o p a e d i c s 1 0 ( 2 0 1 3 ) 3 8 e4 0

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Total knee arthroplasty in patients with peripheral vascular disease

Cited by 22 publications

References 13 publications

Selecting and optimising patients for total knee arthroplasty

Selecting and optimising patients for total knee arthroplasty

The prevalence of arterial and venous abnormalities in asymptomatic patients undergoing total knee arthroplasty

Popliteal lesion due to traction during unicompartmental knee revision surgery

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