Total knee replacements are a very common procedure performed in the United States and elsewhere. Of course, as with any operation there are complications which can occur as a result of the procedure. Vascular complications following total knee replacements are not uncommon. This is particularly true in individuals who have peripheral vascular disease which causes poor blood flow into the lower extremities. One of the most common causes of peripheral vascular disease is diabetes. For those individuals who have femoral-popliteal artery bypasses the risk of vascular complications following total knee replacements is extremely high. Despite peripheral vascular disease and femoral-popliteal bypass grafts, total knee replacements can be performed safely when proper surgical technique is followed and when proper post-operative procedures are followed. If the orthopedic surgeon who performs this procedure does not follow proper technique, there is a high risk of limb loss and destruction of the femoral-popliteal bypass grafts.
Prior to any total knee replacement, the orthopedic surgeon should give a proper informed consent. It is imperative that the orthopedic surgeon refers you to your vascular surgeon for testing and/or a discussion regarding the proposed operation. There is no question that any competent vascular surgeon would advise the orthopedic surgeon not to use a tourniquet during the course of the total knee replacement. The reason for this is because the use of a tourniquet cannot only cause the patient to develop clots in the arteries in the lower extremities, but if bypass grafts are present, tourniquets can cause the bypass grafts to occlude and therefore shut down the blood supply to the lower extremity. A total knee replacement should only be performed in a hospital where there is immediate vascular consultation available. If arterial flow problems exist following a total knee replacement, it is imperative that a vascular surgeon be available to immediately examine and treat the patient in order to restore blood flow to the lower extremity. In short, the facility where the procedure is performed must be equipped to deal with vascular complications.
Currently, this office is representing a 61 year old individual who had peripheral vascular disease which necessitated him having femoral-popliteal bypass grafts in both extremities. The orthopedic surgeon did not consult with the patient's vascular surgeon regarding the status of his grafts nor did he consult the vascular surgeon regarding the proposed surgery. Instead, the orthopedic surgeon performed bilateral total knee replacements with the use of tourniquets on both extremities. After the procedure was performed and the patient was taken to the recovery room, he had pulseless lower extremities. No vascular surgeon was available for consultation. The nurses continued to page the orthopedic surgeon who never responded to the pages. The patient was not seen by any physician for a period of approximately eight (8) hours until finally a vascular surgeon came to see the patient at 11:00 o'clock at night. A determination was made that the patient needed to be transferred to a major university hospital. Regrettably the patient ended up with a below-the-knee amputation in one extremity and the loss of his foot in the other extremity.
In summary, total knee replacements are common procedures performed by orthopedic surgeons. Although complications can occur with any procedure, if the orthopedic surgeon follows applicable standards of care, many of these complications can be avoided. This is particularly true in individuals who have peripheral vascular disease and/or femoral-popliteal bypass grafts. If you are considering a total knee replacement and have vascular issues in your lower extremities, it is extraordinarily important that your orthopedic surgeon and your vascular surgeon communicate prior to surgery. Equally important is the fact that the orthopedic surgeon should, under no circumstances, use tourniquets during the course of the surgical procedure