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Updated Strategies to Treat Acute Arterial Complications
Associated with Total Knee and Hip Arthroplasty
Objective: Traditional treatment of acute arterial complications associated with total knee arthroplasty (TKA) and total hip arthroplasty (THA) has generally included arteriography followed by open surgery. The purpose of this study was to evaluate endovascular treatment of acute arterial complications from TKA and THA as an alternative to open surgery.
Methods: We analyzed our computerized database registry and patient charts for vascular interventions associated with TKA and THA at a high-volume orthopedic hospital to create an updated series.
Results: Between 1989 and 2012, 39,196 TKA (26,374 total: 23,205 primary, 3,169 revisions) and THA (12,822 total: 10,293 primary, 2,529 revisions) were performed. Vascular surgery consultation was provided for treatment of acute ischemia, hemorrhage, ischemia with hemorrhage, and pseudoaneurysm formation. All interventions were performed within 30 days of joint replacement.
A total of 49 (0.13%) acute arterial complications occurred over the 23 year period: 37 (76%) associated with TKA and 12 (24%) with THA. Arterial injury was detected on the same day as the orthopedic procedure in 28 patients, between post-operative days 1-5 in 18 patients, and between post-operative days 5-30 in 3 patients. The arterial complications caused ischemia in 28 patients (58%), hemorrhage in 6 (12%), ischemia with hemorrhage in 5 (20%) and pseudoaneurysm in 10 (20%). Treatment included solely endovascular intervention in 12 (25%), failed endovascular treatment converted to open surgery in 1 (2%), and open surgery alone in 36 (73%) patients. Before 2002, only 6% (2/32) (2 TKA) of patients were successfully treated with endovascular intervention compared to 59% (10/17) (9 TKA, 1 THA) after June 2002 (p=0.0004). There were no deaths and limb salvage was attained in all patients.
Conclusion: Although the majority of acute arterial complications after TKA and THA are diagnosed on the day of arthroplasty, a high clinical awareness for acute arterial injury should also be present in the peri-operative period. Although not always possible, endovascular management is now our preferred treatment for injuries associated with TKA or THA, as it offers substantially shorter time to resolution of vascular complications with less morbidity than surgery and equivalent satisfactory outcomes.