summary TKA Vascular Injury and Bleeding, is a rare, potentially devastating, complication that may occur during TKA most commonly as a result of direct injury to the popliteal artery. Diagnosis is made with visual inspection for significant arterial bleeding and a change in patient hemodynamic status. Treatment is recognization of the injured vessel, hemostasis and vascular consultation. Epidemiology Incidence 0.017%-0.2% Risk factors revision surgery peripheral vascular disease Etiology Causes direct laceration sharp dissection in posterior compartment of knee blunt trauma posterior retractor placement stay medial with single-prong retractor (do not go lateral to PCL) popliteal artery is a lateral structure at the level of the joint line do not insert retractor more >1cm into posterior soft tissues hyperflexion displaces artery and can avoid injury excessive hyperextension brings the artery closer to the knee increases likelihood of injury during bone cuts thrombosis Anatomy Popliteal artery origin before knee a continuation of the superficial femoral artery transition is at hiatus of adductor magnus muscle anchored by insertion of adductor magnus as enters region of posterior knee course in posterior knee relation to anatomy structures of knee lies posterior to the posterior horn of the lateral horn of the lateral meniscus lies directly behind posterior capsule branches within knee at supracondylar ridge gives branches the provide blood supply to the knee above knee joint branches include medial and lateral sural arteries cutaneous branch middle genicular artery at level of knee joint branches include medial genicular artery lateral genicular artery exit of knee anchor as artery exits knee it is anchored by soleus tendon (originates form medial aspect of tibial plateau) distal branches branches into anterior and posterior tibial arteries at distal popliteus muscles Presentation Intraoperative brisk bleeding loss of pulses Postoperative ischemia sensory changes loss of distal pulses skin mottling Imaging Intraoperative angiogram indications if brisk intraoperative bleeding and/or loss of pulses than obtain immediate vascular surgery consultation. vascular consultation will dictate intraoperative imaging, including angiogram. Postoperative CT angiogram indications signs of ischemia loss of pulses skin mottling sensory changes Treatment Immediate vascular surgery consultation indications whenever a concern for injury to the popliteal artery modalities may include nonoperative and observation closed suction drainage is associated with increased incidence of transfusion stent placement bypass endarterectomy prophylactic fasciotomy may be indicated to avoid reperfusion compartment syndrome Complications Compartment syndrome Amputation Mortality Socioeconomic consequences increased length of stay increased cost
Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA Revision Orthobullets Team Recon - TKA Instability Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA - Parapatellar Approach Derek T. Bernstein Stephen Incavo Recon - TKA Templating
QUESTIONS 1 of 4 1 2 3 4 Previous Next (SBQ10HK.56.1) A 62-year-old woman with a valgus knee as seen in Figures A and B who underwent a primary total knee arthroplasty with a tourniquet presents 5 hours postoperatively with severe pain in the extremity and inability to dorsiflex or plantarflex the ankle. Narcotic pain medication does not improve her symptoms. The knee is flexed and the bandage is loosened and she is re-examined one hour later. On examination, the patient is unable to dorsiflex or plantarflex the foot and the pulses are asymmetric. What is the next most appropriate step in management? QID: 214324 FIGURES: A B Type & Select Correct Answer 1 Serial neurologic examinations and EMG in 3 months 15% (242/1635) 2 Pain service consultation for adductor canal block 0% (8/1635) 3 Return to the OR for peroneal nerve exploration 11% (179/1635) 4 Vascular surgery consultation 70% (1146/1635) 5 Thrombectomy 3% (55/1635) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ05.142) A 65-year old healthy male has just undergone primary total knee arthroplasty. Which of the following is associated with use of a closed suction drain in this procedure? QID: 1028 Type & Select Correct Answer 1 Increased incidence of wound dehiscence 1% (51/3614) 2 Increased incidence of transfusion 72% (2603/3614) 3 Decreased incidence of infection 1% (46/3614) 4 Decreased incidence of hematoma formation requiring return to OR 21% (765/3614) 5 Decreased pain scores on post-op days 1 and 2 4% (137/3614) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic
All Videos (1) Podcasts (1) 2018 Orthopaedic Summit Evolving Techniques Evolving Technique Update: The Anemic Patient With A Low Preop Hemoglobin: How I Use Tranexamic Acid & Other Modalities That Helps The Patient & The Hospital - Michael P. Ast, MD (OSET 2018) Michael P. Ast Recon - TKA Vascular Injury and Bleeding D 7/25/2019 1598 views 3.0 (1) Recon⎪TKA Vascular Injury and Bleeding Team Orthobullets 4 Recon - TKA Vascular Injury and Bleeding Listen Now 7:57 min 10/15/2019 95 plays 5.0 (1)