Complications of Total Complications of Total Knee ArthroplastyKnee Arthroplasty

H.Makhmalbaf MDH.Makhmalbaf MDConsultant Orthopaedic & Knee Consultant Orthopaedic & Knee

surgeonsurgeonMashad UniversityMashad University

Prevention of complicationsPrevention of complications

• Preoperative causes

• Perioperative causes

• Intraoperative causes

• Postoperative complications

Preoperative causesPreoperative causes

• Patient selection

• Culture ,BMI, habits, environment

• Patient’s motivation

• Deformity : articular, extraarticular

• Ligament laxity or imbalance

• Previous surgery

• Range of movement

Perioperative causesPerioperative causes

• Operation day, session ,

• Time of surgery

• Surgeon preparation

• Too busy list

• Operating room situation, help, assistant

• Patient positioning

• Anesthesia,

Intraoperative causesIntraoperative 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

PCL retentionPCL retention

Postoperative causesPostoperative causes

• Patients management

• Physiotherapy ,CPM machine

• Rehabilitation

• Wound care

• Range of movement

6yrs post op6yrs post opprevious osteotomyprevious osteotomy

Complications of TKAComplications of TKA

• Medical & mechanical complications

• Prosthetic design related

• Posterior stabilized or cruciate retaining

• Patella resurfacing

Patellofemoral complicationsPatellofemoral 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

Stiffness before & after TKAStiffness 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

Treatment of stiffnessTreatment of stiffness

• During arthroplasty

• After operation

• Physiotherapy

• MUA

• Arthroscopy & release arthrofibrosis

Reoperation after TKAReoperation after TKA

• Femoral component loosening

• Fractured femoral component

• Tibial component loosening

• Patella problems

• Polyethylene insert wear

Instability after TKAInstability after TKA

• Ligament rupture

• Gradual laxity

• Undercorrection of bony deformity

• Cruciate retaining in a PCL deficient knee

• Flexion-extention gap

Infection after TKAInfection after TKA

• A catastrophic disaster

• Early or late

• Early contamination with late presentation

• Acute or chronic

• Metastatic infection

Workup of a septic TKAWorkup 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

Treatment optionsTreatment options

• Closed treatment

• Open synovectomy, debridement, & insert exchange

• Primary prosthetic exchange

• Delayed prosthetic exchange

• Resection arthroplasty

• Knee arthrodesis, & Amputation

Summary:( Richard Scott)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

Prevention of complications:Prevention of complications:before operationbefore operation

• Patient selection

• Operate or not, TKA V UTO

• Prehabilitation

• Timing of surgery

• Operative environment

• Instrumentation

• Selection of prosthesis

Prevention of complications:Prevention of complications:(during operation)(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

Prevention of complicationsPrevention 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

ComplicationsComplications

• In conventional TKA

• In MIS TKA

• In Navigation TKA

• In Navigation + MIS TKA

• Bilateral simultaneous TKA

TKANK YOUTKANK YOU