Aim: Current teaching suggests that patients requiring a Total Knee Replacement (TKR) and who have absent pulses, or an abnormal Ankle Brachial Pressure Index (ABPI) should be referred for vascular investigation. The aim of this study was to see whether TKR was safe in such patients and its effect on ABPI.

Patients and Method: The ABPI was measured in both the dorsalls pedis (DP) and posterior tibial (PT) arteries with a hand held Doppler in 1 00 legs prior to TKR. Patients were excluded from the study if they suffered from active ulceration, rest pain or an absent femoral pulse, but claudicants were included. The ABPl was measured again 5–7 days post-operatively when the grade of surgeon, tourniquet time (if used) and procedure duration were also recorded.

Results: 73 patients (58 women and 15 men) were recruited with a mean age of 69 years. 27 underwent bilateral TKR and 46 unilateral TKR. A tourniquet was used in 92% of procedures. Pre-operatively 36% of foot pulses were impalpable. Hand-held Doppler detected arterial signals from 98% of arteries although 17.5% had an ABPI of < 0.9. Post-operatively there were no signs of limb ischaemia in any patient and the median ABPI’s actually increased significantly (p=0. 00 1 [DP], p=0. 003 [PT]).

Conclusion: From our series of 100 consecutive TKR’s it seems safe to proceed with surgery in patients with impalpable foot pulses or claudication, as long as the femoral pulse is palpable and there is no active ulceration or rest pain.

We report two cases of fungal infection of prosthetic joints which were successfully treated by the incorporation of fluconazole into polymethylmethacrylate beads inserted at the time of debridement.