Vascular injury is a feared complication of any surgical procedure. This study examined the incidence of vascular injury during total knee arthroplasty (TKA), the circumstances and timing of injury intraoperatively, and acute management. Eighteen cases of catastrophic vascular injury after primary TKA (12 of 19,577; 0.06%) or revision TKA (6 of 4453; 0.1%) were identified. Catastrophic injury was defined as any vascular injury requiring vascular surgery. Chart review was performed to identify the timing of vascular injury, the injured blood vessel, and acute management. The Knee Society Score (KSS) was calculated. Mean follow-up was 8 years. Surgical indications included primary osteoarthritis for 12 cases, reimplantation for infection for 3 cases, and aseptic revision for 3 cases. Vessel injury included the popliteal artery in 10 cases, the popliteal artery and vein in 5 cases, and the popliteal vein in 3 cases. Thirteen injuries occurred during tibial preparation. Management included thrombectomy and reanastomosis in 15 cases and vessel bypass in 3 cases. One patient had thrombosis and limb ischemia 2 days after repair, requiring bypass. No amputations had occurred at late follow-up. Mean KSS was 74 at latest follow-up. Catastrophic vascular injury is more common after revision TKA (1 of 1000) than after primary TKA (6 of 10,000). Most injuries occur during tibial preparation. If identified quickly and addressed promptly by vascular surgery, limb salvage is likely. [Orthopedics. 2022;45(6):340-344.].
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