Updated strategies to treat acute arterial complications associated with total knee and hip arthroplasty

Abstract

Although the majority of acute arterial complications after TKA and THA are diagnosed on the day of surgery, a high clinical awareness for acute arterial injury should also be present in the postoperative period. Although not always feasible, endovascular management is now our preferred treatment for injuries associated with TKA or THA. This offers substantially shorter time to vascular restoration, with less morbidity than open repair, and equivalent satisfactory outcomes.

The national incidence of iatrogenic popliteal artery injury during total knee replacement

“…Case series from single institutions or and small multicenter studies place the incidence between 0.03 and 0.17%. 2,[7][8][9][10] This uncommonness of popliteal vasculature injury during TKR makes studies about its overall incidence, trends and outcomes difficult at a local level. The National Inpatient Sample (NIS) is a large, national database inclusive of a 20% stratified sample of all inpatient hospital admissions to non-governmental hospitals in the USA.…”

Effects of the timing of tourniquet release in cemented total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

“…Last but not the least, tourniquet release for hemostasis before wound closure would be a practical way to determine the major vascular damage. According to a recent epidemical survey, the rate of acute arterial complications was about 0.1% (37 of 39,196 TKAs) from 1989 to 2012 [ 52 ]. Although major vascular injury in TKA is very rare, early recognition and expeditious management of these injuries are critical for successful outcomes.…”

Surgical Treatment of a Popliteal Artery Pseudoaneurysm after Total Knee Arthroplasty

“…Popliteal artery is the most frequently affected artery due to its proximity to the joint. The incidence of popliteal pseudoaneurysm after a TKA varies from 0.03 to 0.5% [1,2,[6][7][8]. It is more frequent in revision than in or surgery as in our case, with good short-term results.…”

“…In relation to the treatment of popliteal pseudoaneurysms, there are several therapeutic strategies. Open surgery by vein bypass has been widely used with excellent long-term results [8]. However, it is hampered by the presence of fibrosis and anatomical changes due to previous surgery, which increase the risk of injury of adjacent structures and prosthesis infection [1].…”

“…The incidence of popliteal pseudoaneurysms after TKA varies from 0.03 to 0.5% depending on the series [1,2,[6][7][8]. Clinically, they present as a pulsatile hemat-primary surgeries due to the existence of fibrosis that hinders dissection of tissues [6].…”