Diagnosis and Treatment of Arterial Occlusion after Knee Arthroplasty: The Sooner, the Better

Abstract

Knee arthroplasty, including total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA), is an effective procedure for patients with severe knee joint diseases. Arterial occlusion after knee arthroplasty is a rare but severe complication. However, there are few comprehensive reviews or analyses focusing on it. In this study, we presented a case of successful treatment of acute arterial occlusion of the popliteal artery after TKA by emergent balloon angioplasty, and conducted a review and analysis of published cases with this complication. After search and screening, 36 studies with 47 cases of arterial occlusion after knee arthroplasty in the past 35 years (1984–2018) were included. Among the 47 patients, there were 22 men and 25 women. The mean age was 68 years old. A total of 43 patients had primary TKA while 2 had revision surgery for TKA and 2 for UKA. For arterial occlusions, 66% presented symptoms in less than 1 day after knee surgery and 95% of the occlusion sites were around the popliteal artery. For treatment, 89% chose surgical treatment. Compared with conservative treatment, surgical treatment was more effective (P < 0.01). The patients who underwent surgical treatment less than 1 day after diagnosis had less sequelae (P < 0.05). For arterial occlusion after knee arthroplasty, we should pay attention to the perioperative risk factors and presentations, and diagnose and treat surgically at an early stage.

Delayed Arterial Occlusion Presenting as Foot Drop Following Primary Total Knee Arthroplasty in a Varus Knee: A Case Report and Review of the Literature

“…Early diagnosis and treatment are essential for limb salvage [7]. A review of arterial injuries after TKA by Li et al [11] found pulselessness to be the most common presentation usually occurring within 24 h. We presented a unique case of delayed arterial thrombosis after primary TKA with initial complaints of neurologic dysfunction that required a TMA.…”

“…The most common presenting symptoms after arterial injury following TKA include pulselessness, poikilotherm, pain, paresthesia, pallor, poor capillary refill, paralysis, decreased ABI, mottling, swelling, blistering, and necrosis [11]. Motor weakness can also be a sign of vascular injury.…”

“…One author recommended avoiding a tourniquet in patients with preoperative ABIs less than 0.50, radiographic evidence of vascular calcification, lack of palpable pedal pulses, or known peripheral atherosclerotic disease [2]. The most common presenting symptoms after arterial injury following TKA include pulselessness, poikilotherm, pain, paresthesia, pallor, poor capillary refill, paralysis, decreased ABI, mottling, swelling, blistering, and necrosis [11]. Motor weakness can also be a sign of vascular injury.…”

Acute popliteal thrombus following total knee arthroplasty

“…If a popliteal thrombus develops following TKA, prompt recognition and evacuation with surgery instead of conservative treatment is associated with better outcomes. [ 16 ]…”

Vascular injury following revision knee arthroplasthy: A case report

“…Vascular complications are rarely seen in total knee arthroplasty (TKA), and injuries are classified as (i) iatrogenic vascular injury, (ii) artery occlusion, and (iii) pseudoaneurysm [1]. While there is a low risk of popliteal artery penetrating injuries, iatrogenic vascular injury is seen at the rate of 0.003% [2,3]. Although popliteal artery occlusion following TKA is seen more often than iatrogenic injuries, the rate has been shown to be 0.03%-0.2% [4,5] and the rate of chronic vascular insufficiency after TKA is estimated to be 2% [6].…”