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Complications of total knee arthroplasty

Gregory M Martin, MD
Thomas S Thornhill, MD
Jeffrey N Katz, MD, MSc
Section Editor
Daniel E Furst, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


Complications during and after total knee replacement are uncommon or rare and can often be prevented with meticulous surgical technique and with attentive postoperative management. As with other major surgery, complications may occur, and these include anesthesia-related risks, exacerbation of comorbid medical issues, and medication and allergic reactions.

Complications related specifically to total knee arthroplasty, although uncommon, range from minor problems to devastating, life-threatening events. The incidence of these complications may potentially be reduced if the procedure is performed by a higher volume surgeon and hospital [1]. 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".)


The development of deep venous thrombosis (DVT) with the potential to propagate a potentially lethal pulmonary embolus (PE) is the most feared complication of total knee arthroplasty. The reported incidence of DVT following total knee arthroplasty without prophylaxis ranges from 40 to 88 percent [2]. The incidences of asymptomatic PE, symptomatic PE, and mortality range from 10 to 20 percent, from 0.5 to 3 percent, and up to 2 percent, respectively.

In contrast, the rates of inpatient venous thromboembolism (VTE) and PE among patients receiving prophylaxis following total or partial knee arthroplasty were much lower in estimates from a meta-analysis involving 23,475 patients in 26 randomized trials and observational studies [3]. Venous thromboembolic events, symptomatic DVT, and PE occurred in 1.09 percent (95% CI 0.85-1.33), 0.63 percent (95% CI 0.47-0.78), and 0.27 percent (95% CI 0.16-0.38), respectively.

The prevention, diagnosis, and treatment of DVT and PE after total joint arthroplasty (hip and knee) are discussed separately. (See "Prevention of venous thromboembolic disease in surgical patients" and "Approach to the diagnosis and therapy of lower extremity deep vein thrombosis" and "Clinical presentation, evaluation, and diagnosis of the adult with suspected acute pulmonary embolism" and "Overview of the treatment of lower extremity deep vein thrombosis (DVT)" and "Overview of the treatment, prognosis, and follow-up of acute pulmonary embolism in adults".)


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Literature review current through: Sep 2016. | This topic last updated: Oct 12, 2015.
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