Abstract
Background: Vascular injuries associated with total joint arthroplasty are the most feared complication. The arterial and venous injury can occur due to direct or indirect trauma. A high index of suspicion, recognition of the injury and prompt treatment, with the immediate availability of a vascular surgeon is vital for good outcome.
Methods: Using prospectively collected data on 13624 patients undergoing total joint arthroplasty at our institution, all incidences of vascular injury were identified. Detailed data regarding the mode of presentation, the type and the outcome of intervention delivered, and the eventual functional outcome of the total joint arthroplasty were determined.
Results: There were a total of 17 vascular injuries (0.1%). Majority (16/17) of these vascular injuries were detected in the postoperative recovery area. 9 injuries occurred after TKA and 8 occurred after THA. Indirect injury was the mechanism in TKA patients with popliteal artery thrombosis being the mechanism. In contrast direct injury was the mechanism in THA patients. Fasciotomy was performed in all TKA patients and none were needed in the THA patients. One patient died of complications related to vascular injury. 12 of 17 patients (70%) had launched a legal suit against the operating surgeon.
Conclusions: After more than 80 years of accumulated experience and more than 35000 joint replacements performed by 5 surgeons in our center, the vascular complication still continues to occur. Patient awareness regarding this real problem may play a role in defraying the extremely high likelihood of legal suits associated with this complication.
Correspondence should be addressed to Ms Larissa Welti, Scientific Secretary, EFORT Central Office, Technoparkstrasse 1, CH-8005 Zürich, Switzerland
