Vascular Complication of Knee Arthroplasty Under Tourniquet

An 80-year-old white male was treated with a right total knee arthroplasty after three years of incapacitating knee pain that did not respond to conservative therapy. A pneumatic tourniquet was placed around the right proximal thigh prior to surgery. Before applying the dressing, assessment of the right foot revealed an adequate vascular status. On the first postoperative morning, the popliteal and pedal pulses were absent. An arteriogram identified complete occlusion of the distal superficial femoral artery and popliteal artery down to and including the trifurcation. After a right femoral artery embolectomy, the pulses returned and the patient suffered no residual deficit from the arterial occlusion. The patient had a prior history of prostatic carcinoma and was taking diethylstilbestrol; these factors, along with age-associated atherosclerotic disease and the tourniquet application, created a favorable environment for such a rare complication. Factors that may compromise vascularity when using the pneumatic tourniquet must be given due consideration.