The effect of the ankle brachial pressure index and the use of a tourniquet upon the outcome of total knee replacement

Current teaching suggests that patients requiring a total knee arthroplasty who have absent pulses or an abnormal ankle-brachial pressure index (ABPI) should be referred for vascular investigation. The aim of this study was to determine whether total knee arthroplasty was safe in such patients. The ABPI was measured with a hand-held Doppler. Patients were excluded if they had active ulceration, rest pain, or an absent femoral pulse, but patients with claudication were included. A total of 73 patients were recruited. Hand-held Doppler detected signals from 98% of arteries. Postoperatively, there were no signs of limb ischemia, and the median ABPIs increased significantly. From our series, it seems safe to proceed with surgery in patients with impalpable foot pulses or claudication, as long as the femoral pulse is palpable and there is no active ulceration or rest pain.