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Popliteal vascular injury during total knee arthroplasty
Monica S Da Silva1, Michael Sobel,
1Department of Surgery, SUNY Upstate Medical University and the Veteran Affairs Medical Center, Syracuse, New York 13210, USA. dasilvam@upstate.edu
Background:
Popliteal vascular injury during total knee arthroplasty (TKA) is rare. Although the etiology, management, and outcome of this injury have not been systematically studied, several anecdotal reviews and small case series have suggested a high morbidity, with tourniquet injury as a predominant etiology.
Methods:
We surveyed 190 members of a major regional vascular society concerning their experiences with popliteal vascular injuries sustained during TKA, specifically regarding the presentation, mechanisms of injury, diagnostic studies, surgical exposure and methods of repair, and outcomes.
Results:
Thirteen surgeons provided data (6.8% response rate) on 19 patients with TKA-related popliteal artery injuries. In contrast to the historical literature, sharp, direct trauma was the predominant etiology of vascular injury. Vascular reconstructive techniques varied, with arterial bypass being the most common. There was no mortality in this series. Eighty-four percent (16/19) of the patients had full recoveries. Limb loss occurred in 2 of the 19 patients (10.5%).
Conclusion:
Popliteal vascular injuries during TKA are primarily the result of direct trauma to the vessel. Prompt diagnosis, extensile vascular exposure through a medial knee surgical incision, and standard reconstructive techniques offer a good prognosis for this limb-threatening complication.