Document Detail

Arterial and ischemic aspects of total knee arthroplasty.
MedLine Citation:
PMID:  1415922     Owner:  NLM     Status:  MEDLINE    
Prospective and retrospective analyses of 1,182 consecutive patients undergoing primary total knee arthroplasty (TKA) were performed to determine (1) the incidence of chronic lower extremity ischemia (CLEI); (2) the effect of tourniquet occlusion; and (3) guidelines that will allow TKA to be performed safely. Despite the appropriately advanced age of our patients, the incidence of CLEI was only 2%. All ischemic complications occurred in six patients with CLEI (25%), but none resulted in death or amputation. The ischemic complications consisted of pressure-induced necrosis of toes, heel, or foot, atheroembolism, femoral-popliteal graft occlusion, and asymptomatic popliteal occlusion. Tourniquet compression in the 1,158 patients without CLEI produced no untoward effects. Patients with mild CLEI can have a TKA performed safely with a tourniquet if there is no femoropopliteal calcification. When the ischemia is severe or there is a femoropopliteal aneurysm, arterial reconstruction should precede the TKA. In patients with patent femoral-popliteal bypasses or calcification without ischemia, TKA should be performed without a tourniquet. Ischemic pressure necrosis is an additional mechanism of injury.
D A DeLaurentis; K A Levitsky; R E Booth; R H Rothman; K D Calligaro; C A Raviola; R P Savarese
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of surgery     Volume:  164     ISSN:  0002-9610     ISO Abbreviation:  Am. J. Surg.     Publication Date:  1992 Sep 
Date Detail:
Created Date:  1992-10-29     Completed Date:  1992-10-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  237-40     Citation Subset:  AIM; IM    
Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia.
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MeSH Terms
Aged, 80 and over
Arterial Occlusive Diseases / epidemiology,  etiology
Chronic Disease
Femoral Artery*
Ischemia / epidemiology,  etiology*
Knee Prosthesis / adverse effects*
Leg / blood supply*
Middle Aged
Popliteal Artery*
Prospective Studies
Retrospective Studies
Tourniquets / adverse effects*

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