Vascular injury during primary total knee arthroplasty: A nationwide study

Purpose: To evaluate the incidence, risk factors, mortality, and complications of direct vascular injury (VI) in patients who underwent primary total knee arthroplasty (TKA) using data from a nationwide database. Methods: Data were collected from the National Health Insurance Research Database of Taiwan. The study group included 111,497 patients who underwent TKA from January 2004 to December 2011. In total, 15 cases of direct VI were reported (VI group). We analyzed the incidence, risk factors, mortality, complications of direct VI and hospital stays between groups (VI group and non-VI group). Results: Average incidence of VI was 13.74 per 100,000 person-years. No patient-dependent risk factors for VI were identified. Surgeons with low surgical volume highly correlated with incidence of VI (P < 0.05). 90-day mortality was significantly higher (33.3% vs. 0.37%) and length of hospital stay was significantly longer (19.43 days vs. 7.26 days) in the VI group than in the control group. In addition, incidence of periprosthetic joint infection, restenosis at the injury site, and limb loss were significantly higher in the VI group than in the control group. Conclusion: VI during primary TKA was associated with significantly higher incidence of periprosthetic joint infection, restenosis at the injury site, and limb loss, as well as higher 90-day mortality. Therefore, surgeons should be aware of VI during primary TKA, especially those with low surgical volume. Keywords: Vascular injury, Total knee arthroplasty, Surgical volum