title: Severe vascular complications and intervention following elective total hip and knee replacement: A 16-year retrospective analysis.
abstract: BACKGROUND
  Iatrogenic vascular injuries associated with elective orthopaedic joint procedures are relatively rare, however when they do occur they carry a risk of significant morbidity and mortality. The aim of this study was to investigate the incidence of vascular complications and resultant need for specialist intervention following elective total hip replacement (THR) and total knee replacement(TKR).
  
  
  METHODS
  This was a retrospective analysis of prospectively collected data. The primary outcome measure was vascular complication requiring an interventional radiology procedures or vascular surgery. As a secondary outcome measure postoperative Modified Knee Society Scores and Harris Hip Scores were analysed to assess long term clinical outcome.
  
  
  RESULTS
  Six cases of vascular injury requiring specialist intervention were identified. From 2073 total TKRs there were one cases of popliteal artery injury, one case of venous injury and two case of lateral geniculate artery injury (0.19%). From 1601 THRs there were two cases (0.12%) of arterial injury. All patients were treated successfully by a vascular surgeon or an interventional radiologist. Patient outcome varied considerably with the poorest results seen in the THR group.
  
  
  CONCLUSIONS
  Iatrogenic vascular complications following elective THR and TKR carry a risk of significant morbidity and mortality. It is important that surgeons and trainees performing these procedures are conscious of these risks and able to identify vascular injuries promptly when they occur. Detailed preoperative assessment, an awareness of anatomical variants and close liaison with a vascular surgeon may all help to reduce the number and severity of adverse outcomes.
authors.affiliation: Department of Orthopaedic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
authors.forename: Erez
authors.initials: E
authors.lastname: Avisar
authors.affiliation: Department of Orthopaedic Surgery, University London College Hospital, London, NW1 2BU, United Kingdom.
authors.forename: Michael Haward
authors.initials: MH
authors.lastname: Elvey
authors.affiliation: Department of Orthopaedic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Bar-Ziv
authors.affiliation: Department of Orthopaedic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Tamir
authors.affiliation: Department of Orthopaedic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Agar
keywords: Angiography; Arthroplasty; Total hip replacement; Total knee replacement; Vascular complications