Vascular injuries associated with total knee arthroplasty


  • Narayan Hulse Department of Orthopedics, Fortis Hospital Bannerghatta Road, Bangalore, India
  • Prashanth Naik Department of Orthopedics, Fortis Hospital Bannerghatta Road, Bangalore, India
  • Naveen Dilip Department of Orthopedics, Fortis Hospital Bannerghatta Road, Bangalore, India
  • Nagabhushan K. N. Department of Orthopedics, Fortis Hospital Bannerghatta Road, Bangalore, India
  • Adarsh Krishna K. Bhat Department of Orthopedics, Fortis Hospital Bannerghatta Road, Bangalore, India



Complications of total knee arthroplasty, Vascular injury, Popliteal artery injury, Iatrogenic vascular injury


Iatrogenic vascular injuries are rare but potentially devastating complications of total knee arthroplasty (TKA). This retrospective study analyzes vascular injuries associated with total knee arthroplasties in an urban, tertiary level referral hospital between 01 April 2010 to 31 March 2020 consisting of 6548 TKAs. Six patients sustained vascular injuries which included five primary, and one revision TKAs. Three patients were bilateral, and two were unilateral primary TKAs. The mean age-adjusted Charlson’s comorbidity index was two (range 1-3). Only two injuries were recognized intraoperatively. They underwent successful vascular repair. The third patient was diagnosed and underwent a vascular repair on the first postoperative day but experienced a permanent foot drop. Two other patients underwent thrombectomy on the fifth postoperative day; one required above-knee amputation, and the other continued to suffer from vascular claudication and paraesthesia. Another patient developed a pseudoaneurysm, which was identified and repaired five months after the primary TKA. The site of vascular injury was popliteal artery in five and superficial femoral artery in one patient. The mechanism of injury was a direct laceration in three, posterior Hohman's retractor in one, the effect of tourniquet on calcified vessels in one, and unknown in one patient. Early recognition was the only factor that significantly altered the functional outcome and limb salvage. Bilateral simultaneous total knee arthroplasties had no higher risks. A mandatory institutional protocol to recognize the early signs of vascular injuries is necessary for successful vascular repair.

Author Biographies

Narayan Hulse, Department of Orthopedics, Fortis Hospital Bannerghatta Road, Bangalore, India

Director, Depatment of Bone & Joints

Prashanth Naik, Department of Orthopedics, Fortis Hospital Bannerghatta Road, Bangalore, India

Senior Registrar, Department of Orthopaedics

Naveen Dilip, Department of Orthopedics, Fortis Hospital Bannerghatta Road, Bangalore, India

Consultant, Department Of Orthopaedics

Nagabhushan K. N., Department of Orthopedics, Fortis Hospital Bannerghatta Road, Bangalore, India

Consultant, Department of Vacular Surgery

Adarsh Krishna K. Bhat, Department of Orthopedics, Fortis Hospital Bannerghatta Road, Bangalore, India

Senior Registrar, Department of Orthopaedics


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