[Cause analysis and clinical management of postoperative wound complications after total knee arthroplasty]

Zhenhui Sun, Yunbo Sun, Jiangang Cao, Lei Wang, Mengqiang Tian, Yu Zhang, Jun Liu, Pei Wang
Chinese Journal of Reparative and Reconstructive Surgery 2009, 23 (6): 644-7

OBJECTIVE: To investigate the causes and the clinical treatment methods of postoperative wound complications following total knee arthroplasty (TKA).

METHODS: From June 2005 to August 2008, 486 cases (576 knees, including 314 left knees and 262 right knees) underwent primary TKA using standard midline incision and medial parapatellar arthrotomy. There were 146 males (172 knees) and 340 females (404 knees) aged 51-86 years old (average 61.3 years old). The duration of disease was 3-35 years. Primary diseases included: 138 cases (156 knees) of rheumatoid arthritis, 282 cases (348 knees) of osteoarthritis, 46 cases (49 knees) of traumatic arthritis, 20 cases (23 knees) of pigmented villonodular synovitis. The factors of etiology, deformity correction, duration of tourniquet use and wound drainage were analyzed to determine the cause of postoperative wound complication.

RESULTS: Postoperatively, 37 cases (43 knees) had wound complications and the rate of incidence was 7.5%, including 13 cases (15 knees) of aseptic exudation, 3 cases (4 knees) of fat liquefaction, 4 cases (4 knees) of subcutaneous hematoma, 8 cases (9 knees) of flap margin necrosis, 6 cases (7 knees) of superficial infection, 3 cases (4 knees) of red swollen joint with increased skin temperature and deep infection. All 37 patients recovered after symptomatic treatment. Among those 37 cases, patients with rheumatoid arthritis had a higher incidence rate of wound complication than the patients with other primary diseases (P < 0.05). The incidence rate of patients with deformity correction more than or equal to 20 degree was significantly higher than that of other patients (P < 0.05). The duration of using tourniquet was (86 +/- 15) minutes for patients with wound complication, and (78 +/- 8) minutes for patients without wound complication, indicating there was a significant difference (P < 0.01). Wound complication occurred in 22 knees (5.1%) with autologous blood transfusion absorber, 11 knees (11.5%) with negative pressure attraction, and 10 knees (19.2%) receiving no drainage. The incidence rate of postoperative wound complication in patients without drainage was obviously higher than that in patients with drainage (P < 0.05).

CONCLUSION: Patients with rheumatoid arthritis are more likely to have wound complication after TKA. Postoperative wound drainage and short duration of tourniquet application help decrease the incidence of complications. It is necessary to make early definitive diagnosis of postoperative wound complication, and provide proactive treatment.

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