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

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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


Pcl retention

PCL retention


Postoperative causes

Postoperative causes

  • Patients management

  • Physiotherapy ,CPM machine

  • Rehabilitation

  • Wound care

  • Range of movement


6yrs post op previous osteotomy

6yrs post opprevious osteotomy


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


Tkank you

TKANK YOU


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