Complications of total knee arthroplasty
- Gregory M Martin, MD
Gregory M Martin, MD
- Medical Director, Orthopedic Institute at JFK Medical Center
- Preferred Orthopedics of the Palm Beaches
- Section Editor
- Daniel E Furst, MD
Daniel E Furst, MD
- Section Editor — Treatment Issues in Rheumatology
- Clinical professor, University of Washington, Seattle
- Clinical professor, University of Florence, Florence, Italy
- Professor of Rheumatology, University of California in Los Angeles (Emeritus)
- Director of Research, Pacific Arthritis Associates
Total knee arthroplasty is widely considered a safe and effective procedure for patients with end-stage degenerative or inflammatory arthritis of the knee. Nevertheless, complications during and after total knee replacement may occur. These include anesthesia-related risks, exacerbation of comorbid medical issues, medication and allergic reactions, and complications related more specifically to total knee arthroplasty.
Complications related to total knee arthroplasty, although uncommon, range from minor problems to devastating, life-threatening events. The incidence of some of these complications may potentially be reduced if the procedure is performed by a higher volume surgeon and hospital . Efforts should be made to minimize the risk of complications with appropriate patient selection and optimization, meticulous surgical technique, and attentive postoperative management. This topic discusses complications of total knee arthroplasty. The indications for, alternatives to, and surgical technique for total knee arthroplasty are presented separately. (See "Total knee arthroplasty".)
Peroneal nerve palsy — The most common neurologic complication after total knee arthroplasty is peroneal nerve palsy. Clinical manifestations include paresthesia, numbness, and extensor weakness (drop foot). Patients with severe valgus alignment in combination with a flexion deformity are at greatest risk.
If noticed in the postoperative period, the surgical dressings are immediately loosened, and the knee is flexed to relieve pressure on the nerve. Nerve recovery is variable. As an example, one study found that 50 percent of episodes of peroneal palsy had a full recovery; patients with some residual nerve function recovered more often than those with complete palsies .
Tourniquet-related nerve injury — Tourniquet use, common in total knee arthroplasty, may be associated with nerve injury due to compression and/or ischemia. However, studies indicate nerve injury from tourniquet use is quite rare, especially when used at lower tourniquet pressures and for shorter time periods [3,4].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- INTRAOPERATIVE COMPLICATIONS
- Neurologic injuries
- - Peroneal nerve palsy
- - Tourniquet-related nerve injury
- Arterial injuries
- POSTOPERATIVE COMPLICATIONS
- Myocardial infarction
- Aseptic loosening
- Patellofemoral disorders
- - Patellofemoral instability
- - Patellar component loosening
- - Patellar component failure
- - Patella fracture
- - Patella clunk
- - Extensor mechanism rupture
- Periprosthetic fractures
- - Femoral fractures
- - Tibial fractures
- Wound problems
- Polyethylene wear
- Persistent pain and dissatisfaction
- Metal sensitivity
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