Total knee arthroplasty after ipsilateral peripheral arterial bypass graft- Acute arterial occlusion is a risk with or without tourniquet use

A retrospective review was done of the total joint registry at the Mayo Cli nic, Rochester, Minnesota, which contains the computerized records of 19,80 8 consecutive total knee arthroplasties (TKAs) including primary and revisi on that were performed from 1970 to 1997. From that database, 9 patients we re found to have had a TKA after an ipsilateral peripheral arterial reconst ruction. One patient bad had bilateral peripheral arterial reconstruction f ollowed by bilateral TKA, and 10 TKAs were reviewed. Thr medical records we re reviewed retrospectively with particular attention given to the type of peripheral bypass surgery performed, the bypass graft source, the timing of the bypass surgery relative to TKA, the use of a tourniquet at the time of TKA, and the occurrence of complications after TKA. Of the 10 TKAs, 2 pati ents had acute ar arterial occlusion. One patient had a tourniquet, and the other patient did not. There was not a statistical correlation between gra ft type, tourniquet use, timing of surgery, postoperative anticoagulation, and occurrence of arterial occlusion. There is a marked risk of acute throm bosis of an ipsilateral arterial bypass graft after TKA that cannot be elim inated by performing the TKA without a tourniquet. Careful monitoring of th e vascular status of the limb is required in the early postoperative period to detect arterial compromise. Should limb ischemia be suspected, an emerg ent vascular surgery consultation is required, and arterial flow to the low er extremity must be re-established.