Vascular Calcification in Patients Undergoing Total Knee Arthroplasty: Frequency and Effects on the Surgery

다국어 초록 (Multilingual Abstract)

Background: This study aims to investigate the frequency of distal femoral and popliteal arterial calcification and to evaluate the intraoperative and postoperative effects of arterial calcification in patients undergoing total knee arthroplasty using a tourniquet.
Methods: The records of 5,438 patients who had undergone primary total knee arthroplasty between January 2003 and January 2017 were retrospectively reviewed. We examined the preoperative radiographs of the knee from all patients for calcifications of the femoral and popliteal arteries. Vascular calcification was identified on preoperative radiographs in 223 cases. Intraoperative and postoperative complications were investigated among these patients. Postoperative complications were analyzed from the time of surgery to the last follow-up (minimum 1-year follow-up).
Results: Vascular calcification of the arteries around the knee was found in 223 cases (4.1%). The mean patient age was 70.6 years in the non-calcification group and 73.8 years in the calcification group (p > 0.05). The calcification group was classified into medial, intimal, or mixed subgroups according to the morphology of calcification on preoperative radiographs. The medial type included 46 cases (20.6%); intimal type, 161 cases (72.2%); and mixed type, 16 cases (2.7%). There was no statistically significant difference in demographic and surgical data among the three groups. There were intraoperative complications in two cases in the medial type group, both of which involved tourniquet failure. There was also a postoperative complication in one case in the medial type group, which involved wound dehiscence at 2 weeks postoperatively. No other postoperative complications were identified during 1-year follow-up.
Conclusions: Despite the presence of calcifications in the arteries around the knee, total knee arthroplasty (using a tourniquet) can be performed without serious complications.

참고문헌 (Reference)

1 Wilson JS, "Vascular injuries associated with elective orthopedic procedures" 17 (17): 641-644, 2003

2 Parvizi J, "Vascular injuries after total joint arthroplasty" 23 (23): 1115-1121, 2008

3 Woelfle-Roos JV, "Vascular calcifications on the preoperative radiograph:predictor of ischemic complications in total knee arthroplasty?" 31 (31): 1078-1082, 2016

4 Woelfle-Roos JV, "Vascular calcifications on the preoperative radiograph: harbinger of tourniquet failure in patients undergoing total knee arthroplasty?" 46 (46): 1219-1224, 2017

5 Rennenberg RJ, "Vascular calcifications as a marker of increased cardiovascular risk : a meta-analysis" 5 (5): 185-197, 2009

6 Barr L, "Tourniquet failure during total knee replacement due to arterial calcification : case report and review of the literature" 20 (20): 55-58, 2010

7 Abu Dakka M, "Total knee arthroplasty in patients with peripheral vascular disease" 7 (7): 362-365, 2009

8 Vivacqua T, "The use of tourniquet during total knee replacement in patients with and without popliteal artery calcification" 53 (53): 165-170, 2018

9 Ritter MA, "The Anatomical Graduated Component total knee replacement : a long-term evaluation with 20-year survival analysis" 91 (91): 745-749, 2009

10 Koehler SM, "Safety of tourniquet use in total knee arthroplasty in patients with radiographic evidence of vascular calcifications" 44 (44): E308-E316, 2015

11 Abularrage CJ, "Predictors of lower extremity arterial injury after total knee or total hip arthroplasty" 47 (47): 803-808, 2008

12 Da Silva MS, "Popliteal vascular injury during total knee arthroplasty" 109 (109): 170-174, 2003

13 Bernhoff K, "Popliteal artery injury during knee replacement : a population-based nationwide study" 95 (95): 1645-1649, 2013

14 Hozack WJ, "Popliteal aneurysm after total knee arthroplasty : case reports and review of the literature" 5 (5): 301-305, 1990

15 Lehto S, "Medial artery calcification : a neglected harbinger of cardiovascular complications in non-insulin-dependent diabetes mellitus" 16 (16): 978-983, 1996

16 Olivecrona C, "Lower tourniquet cuff pressure reduces postoperative wound complications after total knee arthroplasty : a randomized controlled study of 164 patients" 94 (94): 2216-2221, 2012

17 Cantu Morales D, "Lower extremity arterial calcification on preoperative knee radiographs as a predictor of postoperative cardiovascular events after primary total knee arthroplasty" 33 (33): 1181-1185, 2018

18 Parfenchuck TA, "Intraoperative arterial occlusion in total joint arthroplasty" 9 (9): 217-220, 1994

19 Bernhoff K, "Iatrogenic popliteal artery injury in non arthroplasty knee surgery" 97 (97): 192-196, 2015

20 Georgaklis VA, "Genesis 1 posterior cruciate-retaining total knee arthroplasty with asymmetric tibial tray : an 18-to-26-year long-term clinical outcome study" 26 (26): 838-846, 2019

21 Orr DP, "Correlation of radiographic and histologic findings in arterial calcification" 13 (13): 110-114, 1978

22 Morrey BF, "Complications and mortality associated with bilateral or unilateral total knee arthroplasty" 69 (69): 484-488, 1987

23 Sucker C, "Arteriosclerosis and media sclerosis : a comparison of 2 calcifying vascular diseases" 95 (95): 207-210, 2000

24 Lindbom A, "Arteriosclerosis and arterial thrombosis in the lower limb : a roentgenological study" 80 : 1-80, 1950

25 Smith DE, "Arterial complications and total knee arthroplasty" 9 (9): 253-257, 2001

26 DeLaurentis DA, "Arterial and ischemic aspects of total knee arthroplasty" 164 (164): 237-240, 1992

27 Calligaro KD, "Acute arterial thrombosis associated with total knee arthroplasty" 20 (20): 927-932, 1994

28 Bayne CO, "Acute arterial thrombosis after bilateral total knee arthroplasty" 23 (23): 1239-, 2008

29 Kobayashi S, "Acute arterial occlusion associated with total knee arthroplasty" 119 (119): 223-224, 1999

30 Calligaro KD, "Acute arterial complications associated with total hip and knee arthroplasty" 38 (38): 1170-1177, 2003