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Prospective and retrospective analyses of 1,182consecutive 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.
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Article info
Footnotes
*Supported by a grant from TheJohn F. Connelly Foundation
†Presented at the 20th Annual Meeting of the Society for Clinical Vascular Surgery, Orlando, Florida, March 25–29, 1992.
Identification
Copyright
© 1992 Reed Publishing USA. Published by Elsevier Inc.
