title: Total knee replacement under tourniquet control: A prospective study of the peripheral arterial vasculature using colour-assisted duplex ultrasonography.
abstract: OBJECTIVE
  A tourniquet may potentiate rare and devastating arterial complications after total knee replacement (TKR) in patients with peripheral vascular disease (PVD). Most prior studies that evaluated peripheral arterial blood flow primarily used the ankle-brachial index (ABI).
  
  
  METHODS
  We assessed the prevalence and risk factors for PVD in a cohort undergoing TKR. Clinical and radiological evaluations, including duplex ultrasonography, were performed one week prior to, and six weeks post-TKR performed under tourniquet control. Forty patients were analysed (20 male, 20 female; mean age 67 yrs, range: 53-80 yrs).
  
  
  RESULTS
  Hypertension (50%) and hypercholesterolaemia (50%) were the most common co-morbidities. Distal pulses were present in all patients preoperatively. Six patients (15%) had arterial calcification on their preoperative knee X-rays. Three patients (7.5%) had moderate PVD. There was no change in blood flow postoperatively in patients with or without PVD (p > 0.05). Vascular stenosis was less than 50% in all patients preoperatively and postoperatively. No postoperative vascular complications occurred.
  
  
  CONCLUSIONS
  Severe PVD is not common in patients undergoing TKR. Performing total knee replacement under tourniquet control does not adversely affect the vasculature in patients with less than 50% vascular occlusion.
authors.affiliation: Department of Orthopaedic Surgery, James Connolly Memorial Hospital, Blanchardstown, Dublin, Ireland; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland. Electronic address: raywalls1@hotmail.com.
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Walls
authors.affiliation: Vascular Medicine Unit, James Connolly Memorial Hospital, Blanchardstown, Dublin, Ireland.
authors.forename: Judi
authors.initials: J
authors.lastname: O'Malley
authors.affiliation: Department of Orthopaedic Surgery, James Connolly Memorial Hospital, Blanchardstown, Dublin, Ireland; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland.
authors.forename: Seamus J
authors.initials: SJ
authors.lastname: O'Flanagan
authors.affiliation: Department of Orthopaedic Surgery, James Connolly Memorial Hospital, Blanchardstown, Dublin, Ireland; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland.
authors.forename: Paddy J
authors.initials: PJ
authors.lastname: Kenny
authors.affiliation: Vascular Medicine Unit, James Connolly Memorial Hospital, Blanchardstown, Dublin, Ireland.
authors.forename: Austin L
authors.initials: AL
authors.lastname: Leahy
authors.affiliation: Department of Orthopaedic Surgery, James Connolly Memorial Hospital, Blanchardstown, Dublin, Ireland; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland.
authors.forename: Peter
authors.initials: P
authors.lastname: Keogh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology*; D012307:Risk Factors; D016909:Tibial Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014111:Tourniquets / Q000009:adverse effects*; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*
keywords: Peripheral vascular disease; Total knee replacement; Tourniquet