Does Knee Replacement Surgery Lead to Chronic Limb Ischemia?

ABSTRACT

Total knee replacement (TKR) may be associated with chronic limb ischemia (CLI) due to arterial injury intraoperatively. The aim of this study was to determine the incidence of CLI after TKR surgery. Patients who received a unilateral TKR in 2003–2004 were identified from our database. Patients with diabetes mellitus and preexisting peripheral arterial disease were excluded. Patient assessment was by collection of demographic details, completion of the Oxford Knee Score, Short Form-12 Health Survey, and King's College Hospital's Vascular Quality of Life Questionnaire, and measurement of the ankle brachial pressure index (ABPI). Of the 209 eligible patients, 86 (41%) participated (median age, 73 years; 50% male). Five (5.8%) patients had a reduced ABPI compared with population norms of 4.6 to 7%. Patients with reduced ABPI measurements had higher Oxford Knee Scores, but no relationships between other variables were demonstrated. TKR surgery does not appear to increase the risk of CLI.

KEYWORDS

Knee arthroplasty - complications - arterial disease - vascular - orthopedic

REFERENCES

• 1 Scottish Arthroplasty Project. Information Services Division, Scotland. Scottish Arthroplasty Project: Annual Report 2008. Available at: http://www.arthro.scot.nhs.uk/Reports/Scottish_Arthroplasty_Project_Report_2008.pdf Accessed May 19, 2009
• 2 Kane R L, Saleh K J, Wilt T J et al.. Total Knee Replacement. Evidence Report/Technology Assessment. Minneapolis, MN: Agency for Healthcare Research and Quality; 2003: 86
• 3 DeLaurentis D A, Levitsky K A, Booth R E et al.. Arterial and ischemic aspects of total knee arthroplasty.  Am J Surg. 1992;  164 237-240
• 4 Beard J D, Gaines P A. Vascular and Endovascular Surgery. London, UK: Harcourt Publishers Ltd; 2001
• 5 Rubash H E, Berger R A, Britton C A, Nettrour W S, Seel M J. Avoiding neurologic and vascular injuries with screw fixation of the tibial component in total knee arthroplasty.  Clin Orthop Relat Res. 1993;  286 56-63
• 6 Ninomiya J T, Dean J C, Goldberg V M. Injury to the popliteal artery and its anatomic location in total knee arthroplasty.  J Arthroplasty. 1999;  14 803-809
• 7 Dewhurst G, Wood D A, Walker F et al.. A population survey of cardiovascular disease in elderly people: design, methods and prevalence results.  Age Ageing. 1991;  20 353-360
• 8 Fowkes F GR, Housley E, Cawood E HH, Macintyre C CA, Ruckley C V, Prescott R J. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population.  Int J Epidemiol. 1991;  20 384-392
• 9 Holmberg A, Milbrink J, Bergqvist D. Arterial complications after knee arthroplasty: 4 cases and a review of the literature.  Acta Orthop Scand. 1996;  67 75-78
• 10 Rand J A. Vascular complications of total knee arthroplasty. Report of three cases.  J Arthroplasty. 1987;  2 89-93
• 11 Ware Jr J E, Kosinski M, Keller S D. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.  Med Care. 1996;  34 220-233
• 12 Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement.  J Bone Joint Surg Br. 1998;  80 63-69
• 13 Morgan M BF, Crayford T, Murrin B, Fraser S CA. Developing the Vascular Quality of Life Questionnaire: a new disease-specific quality of life measure for use in lower limb ischemia.  J Vasc Surg. 2001;  33 679-687
• 14 Scottish Intercollegiate Guidelines Network .Diagnosis and Management of Peripheral Arterial Disease. NHS Quality Improvement; Edinburgh, Scotland 2006: 89
• 15 Yao S T, Hobbs J T, Irvine W T. Ankle systolic pressure measurements in arterial disease affecting the lower extremities.  Br J Surg. 1969;  56 676-679
• 16 Baker J D, Dix D E. Variability of Doppler ankle pressures with arterial occlusive disease: an evaluation of ankle index and brachial-ankle pressure gradient.  Surgery. 1981;  89 134-137
• 17 Bland J M, Altman D G. Statistical methods for assessing agreement between two methods of clinical measurement.  Lancet. 1986;  1 307-310
• 18 Paton R W, Neal N C. Doppler assessment of blood flow to the lower limb associated with total knee arthroplasty.  J R Coll Surg Edinb. 1991;  36 81-82
• 19 Scriven M W, Fligelstone L J, Oshodi T O, Stavri G, Pugh N, Lane I F. The influence of total knee arthroplasty on lower limb blood flow.  J R Coll Surg Edinb. 1996;  41 323-324
• 20 Patil S, Allan D B, Quin R. Effect of total knee arthroplasty on blood flow to the lower limb: a prospective clinical study and review of literature.  J Arthroplasty. 2002;  17 882-886