title: Arterial and ischemic aspects of total knee arthroplasty.
abstract: Prospective and retrospective analyses of 1,182 consecutive patients undergoing primary total knee arthroplasty (TKA) were performed to determine (1) the incidence of chronic lower extremity ischemia (CLEI); (2) the effect of tourniquet occlusion; and (3) guidelines that will allow TKA to be performed safely. Despite the appropriately advanced age of our patients, the incidence of CLEI was only 2%. All ischemic complications occurred in six patients with CLEI (25%), but none resulted in death or amputation. The ischemic complications consisted of pressure-induced necrosis of toes, heel, or foot, atheroembolism, femoral-popliteal graft occlusion, and asymptomatic popliteal occlusion. Tourniquet compression in the 1,158 patients without CLEI produced no untoward effects. Patients with mild CLEI can have a TKA performed safely with a tourniquet if there is no femoropopliteal calcification. When the ischemia is severe or there is a femoropopliteal aneurysm, arterial reconstruction should precede the TKA. In patients with patent femoral-popliteal bypasses or calcification without ischemia, TKA should be performed without a tourniquet. Ischemic pressure necrosis is an additional mechanism of injury.
authors.affiliation: Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia.
authors.forename: D A
authors.initials: DA
authors.lastname: DeLaurentis
authors.forename: K A
authors.initials: KA
authors.lastname: Levitsky
authors.forename: R E
authors.initials: RE
authors.lastname: Booth
authors.forename: R H
authors.initials: RH
authors.lastname: Rothman
authors.forename: K D
authors.initials: KD
authors.lastname: Calligaro
authors.forename: C A
authors.initials: CA
authors.lastname: Raviola
authors.forename: R P
authors.initials: RP
authors.lastname: Savarese
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000453:epidemiology / Q000209:etiology; D002908:Chronic Disease; D005260:Female; D005263:Femoral Artery; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000453:epidemiology / Q000209:etiology*; D007720:Knee Prosthesis / Q000009:adverse effects*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery; D011446:Prospective Studies; D012189:Retrospective Studies; D014111:Tourniquets / Q000009:adverse effects*