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Complications of total knee arthroplasty

Gregory M Martin, MD
Section Editor
Daniel E Furst, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


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 [1]. 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".)


Neurologic injuries

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 [2].

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].

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Literature review current through: Dec 2017. | This topic last updated: Sep 15, 2017.
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