Arterial Complications following Total Knee Arthroplasty (TKA): A Systematic Review and Proposal for Improved Monitoring
https://doi.org/10.5704/MOJ.2303.010
- Author:
Hodgson H
1
;
Saghir N
2
;
Saghir R
3
;
Coughlin P
4
;
Scott DJA
5
;
Howard A
6
Author Information
1. Department of Academic Orthopaedics, Leeds Teaching Hospitals NHS Trust, York, United Kingdom
2. Department of Plastic Surgery, Wythenshawe Hospital, Manchester, United Kingdom
3. Department of Orthopaedics, Huddersfield Royal Infirmary, Huddersfield, United Kingdom
4. Department of Vascular Surgery, Addenbrookes Hospital, Cambridge, United Kingdom
5. Leeds Vascular Institute, Leeds General Infirmary, Leeds, United Kingdom
6. Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Publication Type:Journal Article
- Keywords:
total knee arthroplasty, complications, vascular, systematic review
- From:Malaysian Orthopaedic Journal
2023;17(No.1):80-89
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: Total knee arthroplasty (TKA) is a common
operation and is becoming more common due to population
aging and increasing BMI. TKA provides excellent
improvement in quality of life but carries risk of arterial
complications in the perioperative period. This systematic
review aims to provide a greater understanding of the
incidence of such complications, and time taken to diagnose
arterial injury.
Materials and methods: PubMed, Medline, Ovid SP and
EMBASE databases were searched with the following
MeSH keywords: ‘complication’, ‘vascular injury’,
‘ischaemia’, ‘spasm’, ‘thrombosis’, ‘pseudoaneurysm’,
‘transection’, ‘pulse’, ‘ABPI OR ABI’, ‘Doppler’,
‘amputation’. All arterial vascular events in the perioperative
state of the total knee replacement were included. Records
were independently screened by two reviewers, and data was
extracted according to a pre-determined proforma. Overall
incidence and time to diagnosis was calculated for
complications. Systematic review registration PROSPERO:
CRD42018086643. No funding was received.
Results: Twelve studies were selected for inclusion. A total
of 3325 cases of arterial complications were recorded across
all studies, and were divided into three categories,
pseudoaneurysms (0.06%); ischaemia and thrombosis
(0.17%); haemorrhage and arterial transections (0.07%).
Time taken to reach the diagnosis for each complication was
longest in the ischaemia and thrombosis group (6.8 days),
followed by pseudoaneurysm (3.5 days) and haemorrhage
and transections (3.0 days).
Conclusion: TKA post-operative vascular complications are
rare, but when they do occur they lead to limb and life
threatening complications. This should be discussed with
patients during the consent process. Current times to
diagnosis represent missed opportunities to recognise arterial
injury and facilitate rapid treatment of the complication. A
very low threshold for seeking specialist input should be
adopted, and any concern for vascular injury, such as
unexplained perioperative bleeding, absent lower limb
pulses in the post-operative period or unexplained severe
pain should warrant immediate review by a vascular surgeon,
and in centres where this is not possible, immediate bluelight transfer to the closest vascular centre
- Full text:16.2023my1297.pdf
