complications of total knee arthroplasty
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Complications of Total Knee Arthroplasty. H.Makhmalbaf MD Consultant Orthopaedic & Knee surgeon Mashad University. Prevention of complications. Preoperative causes Perioperative causes Intraoperative causes Postoperative complications. Preoperative causes. Patient selection

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complications of total knee arthroplasty

Complications of Total Knee Arthroplasty

H.Makhmalbaf MD

Consultant Orthopaedic & Knee surgeon

Mashad University

prevention of complications
Prevention of complications
  • Preoperative causes
  • Perioperative causes
  • Intraoperative causes
  • Postoperative complications
preoperative causes
Preoperative causes
  • Patient selection
  • Culture ,BMI, habits, environment
  • Patient’s motivation
  • Deformity : articular, extraarticular
  • Ligament laxity or imbalance
  • Previous surgery
  • Range of movement
perioperative causes
Perioperative causes
  • Operation day, session ,
  • Time of surgery
  • Surgeon preparation
  • Too busy list
  • Operating room situation, help, assistant
  • Patient positioning
  • Anesthesia,
intraoperative causes
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
postoperative causes
Postoperative causes
  • Patients management
  • Physiotherapy ,CPM machine
  • Rehabilitation
  • Wound care
  • Range of movement
complications of tka
Complications of TKA
  • Medical & mechanical complications
  • Prosthetic design related
  • Posterior stabilized or cruciate retaining
  • Patella resurfacing
patellofemoral complications
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
stiffness before after tka
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
treatment of stiffness
Treatment of stiffness
  • During arthroplasty
  • After operation
  • Physiotherapy
  • MUA
  • Arthroscopy & release arthrofibrosis
reoperation after tka
Reoperation after TKA
  • Femoral component loosening
  • Fractured femoral component
  • Tibial component loosening
  • Patella problems
  • Polyethylene insert wear
instability after tka
Instability after TKA
  • Ligament rupture
  • Gradual laxity
  • Undercorrection of bony deformity
  • Cruciate retaining in a PCL deficient knee
  • Flexion-extention gap
infection after tka
Infection after TKA
  • A catastrophic disaster
  • Early or late
  • Early contamination with late presentation
  • Acute or chronic
  • Metastatic infection
workup of a septic tka
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
treatment options
Treatment 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 before operation
Prevention of complications:before operation
  • Patient selection
  • Operate or not, TKA V UTO
  • Prehabilitation
  • Timing of surgery
  • Operative environment
  • Instrumentation
  • Selection of prosthesis
prevention of complications during operation
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
prevention of complications1
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
complications
Complications
  • In conventional TKA
  • In MIS TKA
  • In Navigation TKA
  • In Navigation + MIS TKA
  • Bilateral simultaneous TKA
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