# Endovascular Therapy as an Emerging Paradigm for the Treatment of Popliteal Artery Thrombosis Following Total Knee Arthroplasty: A New Approach to Acute Limb Ischemia Management

## TL;DR

This study explores a rare but serious complication of knee replacement surgery and shows that endovascular therapy is an effective treatment for restoring blood flow and reducing complications.

## Contribution

The study introduces endovascular therapy as a novel and effective treatment for popliteal artery thrombosis after total knee arthroplasty.

## Key findings

- Five cases of acute limb ischemia were identified in 1020 TKA procedures, with a 0.49% incidence rate.
- Endovascular treatment, including thrombosuction and balloon dilatation, led to recovery in four out of five cases.
- Early recognition and intervention were critical in mitigating adverse outcomes from this rare complication.

## Abstract

Objectives: The objective of this research was to examine the occurrence, clinical features, treatment approaches, and results associated with a rare complication of thrombosis of the popliteal artery after total knee arthroplasty (TKA), leading to acute limb ischemia (ALI).

Methods: A retrospective study on 1020 TKA procedures spanning 5 years. Cases of ALI were identified through clinical evaluation and arterial Doppler studies. Peripheral angioplasty was done to recanalize the popliteal artery. Manifestations, complications, and management strategies were evaluated.

Results: Among the 1020 TKA cases, 5 cases of ALI were identified which accounts for 0.49% of all TKA cases. Female predominance and left-sided presentations are notable observations. Most patients presented within 8 hours of symptom onset with diverse complications ranging from foot drop to compartment syndrome. Except for 1 case, all patients recovered with thrombosuction and balloon dilatation.

Conclusions: A rare but potentially fatal complication of TKA is popliteal artery thrombosis leading to ALI so it becomes important for early recognition and intervention to mitigate the adverse outcomes. In our study, endovascular treatment has emerged as the preferred modality in terms of effective management and reducing complications and morbidity from surgical procedures.