ACUTE ARTERIAL THROMBOSIS ASSOCIATED WITH TOTAL KNEE ARTHROPLASTY

Purpose: Acute arterial thrombosis associated with total knee arthropl asty (TKA) is a rare but Limb-threatening complication. The purpose of this report was to determine the incidence and optimal management of these complications by reviewing our extensive orthopedic experience a nd the English-language literature. Methods: Between April 1989 and Ma rch 1994 seven (0.17%) patients had development of acute limb-threaten ing ischemia after 4097 TKAs that were performed at our hospital. Mana gement of these complications included (1) emergency arteriography to define inflow and outflow arteries, (2) use of autologous vein from th e contralateral leg when arterial bypasses were necessary (because TKA s are associated with a high incidence of deep vein thrombosis), and ( 3) early, aggressive revascularization that often required difficult d istal bypasses to achieve limb salvage. Management of our cases are co mpared with treatment of 13 patients described in the literature. Resu lts: Ten patients treated at other hospitals by arterial thrombectomy alone (six cases), sympathectomy alone (two cases), fasciotomy alone ( one case) or delayed arterial bypass resulted in seven major amputatio ns and one death. All seven of our patients and three patients treated elsewhere underwent emergency femorodistal bypasses (six tibial, thre e below-knee popliteal, one pedal). All 10 patients had limb salvage a fter long-term follow-up (average 18 months; range 1 to 58). Conclusio n: Thrombectomy alone for acute arterial thrombosis associated with TK A generally is unsuccessful and associated with unacceptably high ampu tation rates. Dismal results without emergency bypass is due to underl ying chronic occlusive atherosclerotic disease found in these patients and intimal plaque disruption that can occur with knee manipulation o r tourniquet compression. Acute arterial occlusion after TKA is best m anaged by emergency arteriography and a femoroinfrageniculate bypass.