The prevention and early recognition of arterial complications in total knee replacement: a vascular surgical perspective

One of the most feared findings following release of a pneumatic tourniquet after total knee arthroplasty, is of an arterial injury. Fortunately, despite the close proximity of the popliteal artery during total knee replacement, vascular injuries during this procedure are infrequent. Estimates of the incidence of serious arterial injury during total knee arthroplasty range from 0.03 to 0.2%, the majority of these presenting as acute thrombosis of the superficial femoral or popliteal arteries. Direct arterial injury at the knee is uncommon but may present in a variety of clinical scenarios ranging from acute haemorrhage on tourniquet release to delayed presentations as false aneurysm or arteriovenous fistula.

Despite the low incidence of arterial injury, the sequelae of such injuries can be severe and prove limb threatening in a large proportion of patients. This is highlighted in a review by Holmberg et al., where 11 of 40 reported cases of arterial injury following total knee arthroplasty resulted in amputation and one in death.