Arterial Injury in Total Knee Arthroplasty (original) (raw)
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Journal of Clinical Orthopaedics and Trauma, 2018
Acute vascular injury during total knee arthroplasty (TKA) is an extremely rare complication, but one which can have devastating consequences threatening the limb and/or life of the patient if not diagnosed and managed at the earliest. The clinical presentation can vary from acute haemorrhage or ischemia in the peri operative period; to a delayed presentation of recurrent swelling and pain secondary to a geniculate or popliteal artery pseudoaneurysm. This is the first reported case of an acute inferolateral genicular artery haemorrhage following TKA and the associated medical complications. It was successfully managed with emergency percutaneous endovascular coiling and appropriate medical management. This case highlights that clinical suspicion, prompt diagnosis and urgent intervention with a multidisciplinary approach can help successfully manage a vascular insult.
International Journal of Medical and Pharmaceutical Case Reports, 2017
Introduction: Routinely patients with hip or knee arthroplasty are transferred from acute clinic to rehabilitationdepartment at an ever earlier stage (one week post-op). The most frequent complications after lower extremity arthroplasty are: local pain, edema, contracture, tardive calcification, infection, hemorrhage, pulmonary embolism and deep vein thrombosis. Sometimes unexpected complications can provoke a delay or even suspension of the rehabilitation. Aims of the Study: The principal objective of the current article is to remind to the wide public the possible presence (and subsequent care) of other complications, e.g. the lower limb arteritis. Case Presentation: The presented patient is 77 years old male. Hospitalized in our PRM Department one week after operation, with the objective of post-op orthopedic rehabilitation after total knee arthroplasty (for advanced gonarthrosis-genu varum with angle 4°). Arterial Echo-Doppler of the lower extremities: Acute thrombosis of the left femoral superficial arteria, and the left popliteal supra-articular arteria (aneurysm of 30 mm), missing images of retro & supra-articular
Vascular injury during primary total knee arthroplasty: A nationwide study
Journal of the Formosan Medical Association = Taiwan yi zhi, 2018
To evaluate the incidence, risk factors, mortality, and complications of direct vascular injury (VI) in patients who underwent primary total knee arthroplasty (TKA) using data from a nationwide database. Data were collected from the National Health Insurance Research Database of Taiwan. The study group included 111,497 patients who underwent TKA from January 2004 to December 2011. In total, 15 cases of direct VI were reported (VI group). We analyzed the incidence, risk factors, mortality, complications of direct VI and hospital stays between groups (VI group and non-VI group). Average incidence of VI was 13.74 per 100,000 person-years. No patient-dependent risk factors for VI were identified. Surgeons with low surgical volume highly correlated with incidence of VI (P < 0.05). 90-day mortality was significantly higher (33.3% vs. 0.37%) and length of hospital stay was significantly longer (19.43 days vs. 7.26 days) in the VI group than in the control group. In addition, incidence o...
Acute Arterial Occlusion After Total Knee Arthroplasty
American Journal of Physical Medicine & Rehabilitation, 2006
There are a number of complications associated with total knee-joint arthroplasty. These include deep venous thromboses, peroneal palsy, infection, anemia, and Ogilvie's syndrome. An uncommon but potentially limb-threatening complication is acute arterial occlusion. Approximately 35 cases have been reported in the orthopedic literature. Prompt recognition and treatment intervention are the keys to successful outcome. We describe the case of one patient who had mild peroneal palsy and developed acute arterial occlusion 9 days postoperatively while on the inpatient rehabilitation service. Prompt aggressive management restored arterial circulation to the lower limb. Careful management of patients after total knee arthroplasty requires an understanding that arterial occlusion is a rare limb-threatening complication of surgery, but that it is treatable with prompt, deliberate management. Physiatrists should be aware that this condition exists in postoperative knee-joint arthroplasty patients. They should pay careful attention to any patient with a history of peripheral vascular disease or postoperative peroneal palsy.
Acute Arterial Thrombosis After Bilateral Total Knee Arthroplasty
The Journal of Arthroplasty, 2008
Arterial thrombosis is a rare complication of total knee arthroplasty (TKA). The overall incidence of arterial complications after TKA, including arterial occlusion, arteriovenous fistula, arterial aneurysm, and arterial severance, varies between 0.03% and 0.17% in reports published in the orthopedic literature (J Vasc Surg 1994;20:927-932). We report a case of acute popliteal artery thrombosis and its sequelae immediately following bilateral TKA performed sequentially under the same anesthesia. This is the first reported case of a post-TKA popliteal artery thrombosis in a patient younger than 60 years without the commonly accepted risk factors.
Predictors of lower extremity arterial injury after total knee or total hip arthroplasty
Journal of Vascular Surgery, 2008
Objective: Lower extremity arterial injury is a rare complication following total knee (TKA) or total hip arthroplasty (THA). To date, no multi-institutional study has identified preoperative factors that may portend increased risk for these injuries. We queried a large clinical database for the incidence and predictors of arterial injury and/or compromise following lower extremity arthroplasty. Methods: Prospectively collected preoperative and postoperative data by the National Surgical Quality Improvement Program (NSQIP) of the Veterans Affairs Medical Centers were analyzed. All patients from 1996 to 2003 in the NSQIP database who underwent TKA or THA were identified via CPT codes. NSQIP defined, 30-day, postoperative outcomes were analyzed. Data were compared using bivariable analysis, as well as limited multivariable logistic regression.
Arterial injury during revision total knee replacement
Knee Surgery, Sports Traumatology, Arthroscopy, 1999
A case of an anatomical variation of the arterial vessels in the popliteal fossa, leading to a vascular transection during a total knee revision is presented. The authors believe this complication should be considered in all cases of knee revision surgery.
Vascular Injuries After Total Joint Arthroplasty
Journal of Arthroplasty, 2008
Vascular injuries, although highly feared, can occur after total joint arthroplasty, often resulting in legal suits. This study evaluates the circumstances related to vascular injuries after joint arthroplasty. Using prospectively collected data on 13 517 patients undergoing total joint arthroplasty at our institution, 16 (0.1%) vascular injuries were identified. Eleven injuries occurred after total knee arthroplasty (TKA) and 5 after total hip arthroplasty (THA). Indirect injury was the most common mechanism in TKA. In contrast, direct injury was most prevalent in THA. One patient died of complications related to vascular injury. Of 16 patients, 8 (50%) had launched a legal suit against the operating surgeon. There appears to be no further specific measure that can be taken to absolutely avoid this complication. Patient awareness regarding this real problem may play a role in defraying the high likelihood of legal suits associated with this complication.
Short-Term Coagulation Complications Following Total Knee Arthroplasty
The Journal of Arthroplasty, 2011
Data from 3278 patients from a prospective patient-centered total joint registry was used to investigate the rates of complications in the first 6 months following primary total knee arthroplasty. All patients reporting deep venous thrombosis (DVT), pulmonary embolism (PE), or major bleeding were identified through patient self-reporting. Complications were verified by a review of imaging records and direct communication with patients by a surgeon. Surgeon-verified rates of DVT, PE, and major bleeding were 1.52%, 0.49%, and 0.34%, respectively. When compared with the complication rates as reported by patients, concordance was 86.2% for DVT, 84.2% for PE, and 36.7% for major bleeding. More than half (54.5%) of the complications were diagnosed and treated at the original operative hospital, and 45.5% were diagnosed and treated at other institutions. Keywords: total knee arthroplasty, complications, deep vein thrombosis, pulmonary embolism, major bleeding, registry.
Blood loss in sequential bilateral total knee arthroplasty
The Journal of Arthroplasty, 1998
This study was devised to determine whether blood loss for sequential bilateral knee arthroplasties was the same for the first and second knees. TWentyeight patients who underwent this procedure were studied along with a control group of patients who underwent unilateral knee arthroplasties. Blood loss was greater in the second knee by a mean of 323 mL (P < .05). The control group and the first knee showed no significant difference in blood loss. Analysis of clotting studies showed a prolongation of prothrombin time, activated partial thromboplastin time, and thrombin time after release of the first tourniquet. Possible reasons for this greater blood loss are discussed.