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

Abstract

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.

The Influence of Diabetes Mellitus on Patients Undergoing Primary Total Lower Extremity Arthroplasty: A Systematic Review and Meta-Analysis

“…With the rising incidence of DM worldwide, the number of DM patients requiring arthroplasty is expected to increase in the future [ 5 ]. Several studies have investigated the impact of DM on the postoperative prognosis for patients undergoing TKA and THA and have indicated that DM patients have an increased rate of infection, vascular disease, and myocardial infarction compared with non-DM patients [ 6 – 8 ]. A meta-analysis published in 2014 reported that patients with DM had a higher risk of deep vein thrombosis, aseptic loosening, deep infection, and periprosthetic fracture after TKA [ 9 ].…”

Incidence of deep vein thrombosis before and after total knee arthroplasty without pharmacologic prophylaxis: a 128-row multidetector CT indirect venography study

“…It was important to calculate the incidences of DVT before and after surgery in patients undergoing TKA to establish appropriate treatment strategies. A previous study found preoperative, asymptomatic vascular disease in 4.6% of patients scheduled for TKA [ 16 ]. Furthermore, 8% of patients had DVT before TKA [ 17 ].…”

Intraoperative indocyanine green angiography for the objective measurement of blood flow

“…Peripheral arterial disease (PAD) is not an uncommon vascular disease. The prevalence of PAD has been reported to range from 1.7% to 15.3% in the Korean population [ 1 2 3 ]. The clinical manifestations of PAD include intermittent pain produced by varying degrees of walking, resting pain, and ischemic wound.…”