Using the Ankle-Brachial Index as a tool to reduce complications in total knee arthroplasty

Abstract

Although arterial complications after Total Knee Arthroplasty (TKA) are rare, results can be devastating for patients, because infection and possibility of amputation are common. Not only can pre-existing peripheral artery disease (PAD) lead to poor healing and increased risk of infection, use of the tourniquet during surgery has been implicated in subsequent arterial complications. Because many of the patients who develop these complications have pre-existing PAD, identifying those at risk should be an integral part of the initial orthopedic patient assessment. Nurses are in a unique position to assess risk factors for PAD in potential candidates for TKA and to decrease risk of postoperative complications by performing the Ankle-Brachial Index (ABI). The test is quick and simple, can be performed in the office and results can be shared immediately with the orthopedic surgeon if follow-up with a vascular surgeon is necessitated. PAD affects at least 10% of adults older than 70 years and will become an increasingly important factor affecting their health care. Although the disease goes unrecognized in about 75% of cases, the clinical presentation of early onset occlusive disease generally manifests itself asymptomatically or in the lower extremities in the form of intermittent claudication (IC). Intermittent claudication is a common and disabling symptom that affects between 3% and 7% of the population and up to 1 in 5 individuals over the age of 75, an age group common to have TKA. Although the symptoms are easy to detect, they are frequently overlooked be-