Total knee arthroplasty in patients with peripheral vascular disease

Vascular complications following total knee arthroplasty (TKA) are rare in the general population; however, the consequence could be devastating and limb threatening. Many of the patients who develop these complications, if not all, have pre-existing peripheral vascular disease (PVD). Following guidelines in the pre-operative assessment, intra-operative procedure and post-operative management in this group of patients can help orthopaedic surgeons to assess candidates for TKA and trim down the arterial complications afterwards. Objective: To propose a strategy to assess TKA candidates with underlying PVD, in order to address the increasing concerns of the orthopaedic surgeons with regard to the likelihood of vascular complications in these patients. Methods: Review of the literature looking for relevant studies and case reports using different medical search engines (PubMed, EMbase and Cochrane Library). Results: Our search produced very few studies relevant to our topic. Most of these are case reports dealing with various vascular complications following TKA and are therefore not helpful in making conclusive recommendations. However, there are a handful of studies that have specifically addressed this issue and have been included in our review. Conclusion: Vascular complications following TKA are rare (<0.5%). There are conflicting views in the literature with regard to the optimum management of these patients. However, patients with risk factors of PVD should be referred to the local vascular surgeons for assessment prior to TKA. The use of tourniquet in these patients is generally not recommended and should be based on the advice obtained from vascular surgeons. Individual orthopaedic surgeons or units, together with their vascular colleagues, should have agreed protocols for pre- and post-operative vascular assessments of patients undergoing TKA.