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Knee Surgery, Perpherial Artery Occulsive Disease, and Nerve Damage
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Knee Surgery, Perpherial Artery Occulsive Disease, and Nerve Damage

This is partly a theoretical question.  Could neurological damage occur during total knee replacement surgery on a patient with undiagnosed popliteal artery occlusion (distal clot within the popliteal artery) with sclerotic changes within the superficial femoral artery?  Patient had complained of chronic light pain/very mild numbness/funny feeling in lower outside and front of leg down across outside of ankle/across top of foot and into instep with some cramping and aching in lower leg on the front prior to surgery.  Later vascular examinations showed popliteal artery occlusion with ankle brachial index at the level of posterior tibial artery 0.67 indicating moderate occulsive disease and at the level of dorsalis pedis artery 0.43 indicating severe occulsive disease.  Surgery done with tourniquet procedure of 39 minutes.
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First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes. Peripheral nerve damage after knee replacement surgery is certainly possible, but the exact conditions that predispose to this injury are not well understood.  The nerves involved are generally the peroneal/deep peroneal and more rarely the femoral, sciatic and saphenous nerves.  The method of injury is not always clear.  It appears that this damage is likely due to direct compression/ischemia by the tourniquet (but injuries have been reported in times <75 minutes with carefully monitored pressures) and some surgeries employ tourniquet times of 2-3 hours (probably the limit) without injury. Peripheral vascular disease, previous back injury/surgery and peripheral neuropathy may predispose to injury.  The use of epidural anesthesia and awkward positioning during surgery have also been implicated in nerve damage.
   I would recommend that you get an EMG/nerve conduction study to evaluate for signs of nerve/muscle damage.  You should also see a vascular surgeon for consultation on your peripheral vascular disease.  Neuropathic pain medications such as Neurontin, Lyrica, Elavil, Pamelor, Maprotiline, Cymbalta, etc. are generally most helpful for pain associated with this type of damage.
I hope this has been helpful.
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A related discussion, Arteriospasm intermittant post arthroscopy was started.
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