Archives of Orthopaedic and Trauma Surgery

, Volume 132, Issue 6, pp 861–865 | Cite as

Position of the popliteal artery in revision total knee arthroplasty

  • Mahmoud M. Abdel Karim
  • Ashraf Anbar
  • Jonathan Keenan
Knee Revision Surgery



Injury to the popliteal artery during total knee arthroplasty is a devastating complication. This topic was studied previously prior to primary total knee arthroplasty. This study aims to demonstrate the position of the popliteal artery in patients prior to revision total knee replacement.


The ultrasound scan results of the position of the popliteal artery in 23 patients were reviewed. The implant/artery distance at different levels was measured with the knee in extension and 70°–90° of flexion.


There was no significant difference in the artery position at the level of the tibial metal base plate (the most critical site) on moving the knee from extension to flexion (P = 0.26). However, the implant/artery distance was found to increase on moving from extension to flexion in relation to the femoral component at the joint line (69%), as well as 15 mm below the level of the tibial base plate representing 69.3%. There was a significant difference at 15 mm above the joint line, where the distance was found to be increased in 84.6% of cases (P = 0.019).


This study has shown that in a revision knee situation, there is no reliable fall back of the popliteal artery in knee flexion; in fact, implant/artery distance may be decreased and caution must be exercised throughout the procedure. It may be worth considering either ultrasound or arteriography in selected cases.


Popliteal artery Revision Knee arthroplasty 



The authors wish to thank Mr Phil Hughes and Mr Abdul Gafoor, Consultant Radiologists, for their assistance with this study.

Conflict of interest

The authors declare that they have no conflict of interests.


  1. 1.
    Adams JC (1992) Standard orthopaedic operations, 4th edn. Churchill Livingstone, Edinburgh, p 398Google Scholar
  2. 2.
    Calligaro KD, DeLaurentis DA, Booth RE et al (1994) Acute arterial thrombosis associated with total knee arthroplasty. J Vasc Surg 20(6):927PubMedCrossRefGoogle Scholar
  3. 3.
    Coventry MB (1973) Osteotomy about the knee for degenerative and rheumatoid arthritis: indication, operative technique and results. J Bone Joint Surg Am 55:23PubMedGoogle Scholar
  4. 4.
    Crenshaw AH (1987) Campbell’s operative orthopaedics, 7th edn. CV Mosby, St. LouisGoogle Scholar
  5. 5.
    DeLaurentis DA, Levitsky KA, Booth RE et al (1992) Arterial and ischemic aspects of total knee arthroplasty. Am J Surg 164(3):237PubMedCrossRefGoogle Scholar
  6. 6.
    Farrington WJ, Charnley GJ, Harris SR, Fox BM, Sharp R, Hughes PM (1999) The position of the popliteal artery in the arthritic knee. J Arthroplasty 14(7):800PubMedCrossRefGoogle Scholar
  7. 7.
    Fortune WP (1986) Complications of total and partial arthroplasty in the knee. In: Epps CH (ed) Complications in orthopaedic surgery. JB Lippincott, Philadelphia, p 949Google Scholar
  8. 8.
    Hozack WJ, Cole PA, Gardner R, Corces A (1990) Popliteal aneurysm after total knee arthroplasty: case reports and review of the literature. J Arthroplasty 5(4):301PubMedCrossRefGoogle Scholar
  9. 9.
    Ninomiya JT, Dean JC, Goldberg VM (1999) Injury to the popliteal artery and its anatomic location in total knee arthroplasty. J Arthroplasty 14(7):803PubMedCrossRefGoogle Scholar
  10. 10.
    Rand J (1987) Vascular complications of total knee arthroplasty: report of three cases. J Arthroplasty 2:89PubMedCrossRefGoogle Scholar
  11. 11.
    Rawes ML, Harper WH, Oni OOA (1996) A serious vascular complication of internal fixation of a tibial plateau fracture. J Trauma 40:323PubMedCrossRefGoogle Scholar
  12. 12.
    Roth JH, Bray RC (1988) Popliteal artery injury during anterior cruciate ligament reconstruction. J Bone Joint Surg Br 70:840PubMedGoogle Scholar
  13. 13.
    Rubash HE, Berger RA, Britton CA et al (1993) Avoiding neurologic and vascular injuries with screw fixation of the tibial component in total knee arthroplasty. Clin Orthop 286:56PubMedGoogle Scholar
  14. 14.
    Rubens F, Wellington JL, Bouchard AG (1990) Popliteal artery injury after tibial osteotomy: report of two cases. Can J Surg 33:294PubMedGoogle Scholar
  15. 15.
    Rush JH, Vidovich JD, Johnson MA (1987) Arterial complications of total knee replacement: the Australian experience. J Bone Joint Surg Br 69(3):400PubMedGoogle Scholar
  16. 16.
    Williams P, Warwick R, Dyson M, Bannister L (1989) Angiology. In: Williams P (ed) Gray’s anatomy. Churchill Livingston, New York, p 785Google Scholar
  17. 17.
    Yoo JH, Chang CB (2009) The location of the popliteal artery in extension and 90 degree knee flexion measured on MRI. Knee 16(2):143–148PubMedCrossRefGoogle Scholar
  18. 18.
    Zaidi SHA, Cob AG, Bentley G (1995) Danger of the popliteal artery in high tibial osteotomy. J Bone Joint Surg Br 77:384PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Mahmoud M. Abdel Karim
    • 1
    • 2
  • Ashraf Anbar
    • 2
  • Jonathan Keenan
    • 1
  1. 1.Department of Orthopaedic Surgery, Plymouth NHS TrustDerriford HospitalPlymouthUK
  2. 2.Department of Orthopaedic SurgeryCairo University HospitalsCairoEgypt

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