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J Knee Surg 2020; 33(10): 1004-1009
DOI: 10.1055/s-0039-1688929
Original Article

Factors Influencing Survivorship in Vasculopathic Patients

Bishoy V. Gad
1   Sports and Orthopaedic Specialists, Adult Reconstruction Surgery, Edina, Minnesota
,
Maxwell K. Langfitt
2   Department of Orthopedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
,
Claire E. Robbins
3   Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
,
Carl T. Talmo
3   Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
,
Oliva Jane Bono
3   Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
,
James V. Bono
3   Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
› Author Affiliations Funding None.
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Abstract

Total knee arthroplasty (TKA) in patients with peripheral vascular disease has sparsely been studied. This study examined patient and radiographic factors that could affect reoperation free survival in these patients. We retrospectively reviewed TKA procedures performed in patients with nonpalpable pulses on physical examination between January 1, 2004, and December 31, 2013. Ninety-two cases met inclusion criteria. Preoperative ankle-brachial index (ABI), date of surgery, sex, age, body mass index (BMI), tourniquet use, American Society of Anesthesiologists (ASA) score, presence of preoperative calcifications, and follow-up data were obtained. Failure was defined as reoperation. Patients were included if they experienced a failure or had at least 2 years of follow-up. Reoperation free survival was calculated by Kaplan–Meier's analysis. Odds ratios (ORs) were calculated for patient factors; hazard ratios (HRs) were calculated by Cox's regression analysis. Ninety-two TKAs were included in the study. Mean age was 68.8 years, mean BMI was 32.15, and mean ASA score was 2.44. Tourniquet was used in 78 patients. Mean preoperative ABI was 1.016. Nine patients had calcifications on X-ray prior to surgery. Reoperation free survival was 9.378 years. Patients with a preoperative ABI of below 0.7 had shorter reoperation free survival (ABI <0.7, 6.854 years; ABI >0.7, 9.535 years; p = 0.015). Patients with a preoperative ABI below 0.7 had greater odds of failure and were at higher risk for earlier failure (OR = 6.5, p = 0.027; HR = 1.678, p = 0.045). When corrected for age, sex, and BMI, the HR for patients with a preoperative ABI below 0.7 worsened (HR = 1.913, p = 0.035) compared with those with an ABI above 0.7. The remaining patient factors produced no statistically significant differences in survivorship, odds of failure, or HRs. No patient factors were associated with increased risk of mortality. These results suggest that patients who undergo TKA with an ABI below 0.7 are at increased risk for reoperation and have shorter reoperation free survival.

Keywords

vasculopathic - ankle-brachial index - total knee arthroplasty


Publication History

Received: 28 February 2019

Accepted: 05 April 2019

Article published online:
23 May 2019

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