Arterial complications of total knee replacement.

Arterial complications of total knee replacement are rare but may be more frequently encountered as the number of replacement arthroplasties increases. An arterial injury may occur on either an acute or chronic basis, leading to ischemia of the lower extremity. The mechanism of injury may be analogous to that encountered in the popliteal artery entrapment syndrome, but may also result from disruptive forces applied to calcified atherosclerotic vessels by the pneumatic tourniquet or during intraoperative manipulation. A thorough preoperative vascular evaluation should be routinely performed in patients with evidence of coexisting peripheral arterial disease, and baseline Doppler segmental pressures should be obtained. Early detection of an arterial injury may prevent the serious consequences that might otherwise occur.