Arterial complications after total knee arthroplasty with or without tourniquet: 6 cases and review of the literature

Murat Calbiyik^1,*, Taner Alic², Ercan Hassa³

¹Department of Orthopedics and Traumatology, Faculty of Medicine, Hitit University, Corum, Turkey - ^2-3Erol Olcok Education and Research Hospital, Hitit University School of Medicine, Corum, Turkey

Introduction: To evaluate the impact of revision surgery and tourniquet use on the prevalence of acute arterial complications associated with total knee arthroplasty.

Materials and methods: A total of 5433 total knee arthroplasty procedures (4997 primer, 436 revision) performed for severe osteoarthritis during between 2000-2020 were retrospectively reviewed. The mean age of patients was 63.7±12.9(42-87) years, and female to male ratio was 1:0.67. A thigh tourniquet was used during surgery in 3542(65.2%) cases, as no tourniquet was used in 1891(34.8%).

Results: Acute arterial injury during surgery was recorded in six patients (0.11%) four in tourniquet group (0.113%) and two in non-tourniquet group (0.107%) (p=1.000). All the cases of acute arterial injury were associated with primary total knee arthroplasty, none of the revision cases had arterial injury. In 3 out of 4 patients in whom a tourniquet was used, it was turned to the prone position and repaired with posterior S incision. In one patient, computed tomography angiography was performed as result of circulatory problems within 6 hours postoperatively, and embolectomy was performed by entering through the femoral artery. No problem was observed in the follow-up. One of the patients who didn’t use a tourniquet was intervened through an anterior incision and repaired primarily. The other patient underwent primary repair through the anterior incision. The patient who developed circulation problem at the 6th hour postoperatively underwent computed tomography angiography. The patient who was found to be lacking circulation underwent primary repair and embolectomy after a posterior incision.

Conclusion: Acute arterial complication is rarely seen in total knee arthroplasty, however due to large number of arthroplasty procedures and serioussness of arterial complications, care should be taken to avoid arterial injuries during arthroplasty, and to provide emergent diagnosis and treatment. The revision surgery and tourniquet use are not clear risk factors for acute arterial complications.