Complications of Total Knee Arthroplasty

1. Complications of Total Knee Arthroplasty H.Makhmalbaf MD Consultant Orthopaedic & Knee surgeon Mashad University

2. Prevention of complications • Preoperative causes • Perioperative causes • Intraoperative causes • Postoperative complications

3. Preoperative causes • Patient selection • Culture ,BMI, habits, environment • Patient’s motivation • Deformity : articular, extraarticular • Ligament laxity or imbalance • Previous surgery • Range of movement

4. Perioperative causes • Operation day, session , • Time of surgery • Surgeon preparation • Too busy list • Operating room situation, help, assistant • Patient positioning • Anesthesia,

5. Intraoperative causes • Surgical technique • Prosthetic design • Prep & drape , leg holder • Operative room condition, laminar flow • Use of turniquet, irrigation, drains • Wound closure,Bandage & dressings • Antibiotics & DVT prophylaxis

7. PCL retention

8. Postoperative causes • Patients management • Physiotherapy ,CPM machine • Rehabilitation • Wound care • Range of movement

9. 6yrs post opprevious osteotomy

10. Complications of TKA • Medical & mechanical complications • Prosthetic design related • Posterior stabilized or cruciate retaining • Patella resurfacing

11. Patellofemoral complications • Account for as much as 50% of complications requiring re-operation • Wear of an unresurfaced patella • Maltracking • Patella fracture • Prosthetic loosening • Osteonecrosis & prosthetic wear

12. Stiffness before & after TKA • Fixed flexion deformity • Limitation of flexion or both • Overall ROM before surgery • Bone stock poor • Deformity corrected during surgery • Developed after surgery • Poor pain control

13. Treatment of stiffness • During arthroplasty • After operation • Physiotherapy • MUA • Arthroscopy & release arthrofibrosis

14. Reoperation after TKA • Femoral component loosening • Fractured femoral component • Tibial component loosening • Patella problems • Polyethylene insert wear

15. Instability after TKA • Ligament rupture • Gradual laxity • Undercorrection of bony deformity • Cruciate retaining in a PCL deficient knee • Flexion-extention gap

20. Infection after TKA • A catastrophic disaster • Early or late • Early contamination with late presentation • Acute or chronic • Metastatic infection

21. Workup of a septic TKA • Status of the wound • The bone cement interface • The organism an it’s sensitivity to AB • The medical status of the patient • Search for another source of infection • ESR & CRP • Knee aspiration for culture & cell count

22. Treatment options • Closed treatment • Open synovectomy, debridement, & insert exchange • Primary prosthetic exchange • Delayed prosthetic exchange • Resection arthroplasty • Knee arthrodesis, & Amputation

23. Summary:( Richard Scott) • It is a devastating complication • Prevention , treatment unnecessary • Incidence of early primary TKA 0.5% • Late infection 1% • Good fortune & implementation of measure • Late infection in RA, UTI, foot ulcers, infected dentition

24. Prevention of complications:before operation • Patient selection • Operate or not, TKA V UTO • Prehabilitation • Timing of surgery • Operative environment • Instrumentation • Selection of prosthesis

25. Prevention of complications:(during operation) • Soft tissue balance • Treat bone defects, cement v bone graft • Flexion extension gap • Bone cuts femur & tibia, limitations • Slope: ant. Post.& mediolateral in tibia • Fractures , Tibia & Femur

26. Prevention of complications: • Rotation & flex extension of femoral comp. • References for femur & tibia rotation • Correct size, no notching • Small mistakes multiply in TKA • Protect ligaments • Prevent fracture

27. Complications • In conventional TKA • In MIS TKA • In Navigation TKA • In Navigation + MIS TKA • Bilateral simultaneous TKA

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