Upload
marcie
View
69
Download
9
Tags:
Embed Size (px)
DESCRIPTION
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 - PowerPoint PPT Presentation
Citation preview
Complications of Total Complications of Total Knee ArthroplastyKnee Arthroplasty
H.Makhmalbaf MDH.Makhmalbaf MDConsultant Orthopaedic & Knee Consultant Orthopaedic & Knee
surgeonsurgeonMashad UniversityMashad University
Prevention of complicationsPrevention of complications
• Preoperative causes
• Perioperative causes
• Intraoperative causes
• Postoperative complications
Preoperative causesPreoperative causes
• Patient selection
• Culture ,BMI, habits, environment
• Patient’s motivation
• Deformity : articular, extraarticular
• Ligament laxity or imbalance
• Previous surgery
• Range of movement
Perioperative causesPerioperative causes
• Operation day, session ,
• Time of surgery
• Surgeon preparation
• Too busy list
• Operating room situation, help, assistant
• Patient positioning
• Anesthesia,
Intraoperative causesIntraoperative 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 retentionPCL retention
Postoperative causesPostoperative causes
• Patients management
• Physiotherapy ,CPM machine
• Rehabilitation
• Wound care
• Range of movement
6yrs post op6yrs post opprevious osteotomyprevious osteotomy
Complications of TKAComplications of TKA
• Medical & mechanical complications
• Prosthetic design related
• Posterior stabilized or cruciate retaining
• Patella resurfacing
Patellofemoral complicationsPatellofemoral 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 TKAStiffness 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 stiffnessTreatment of stiffness
• During arthroplasty
• After operation
• Physiotherapy
• MUA
• Arthroscopy & release arthrofibrosis
Reoperation after TKAReoperation after TKA
• Femoral component loosening
• Fractured femoral component
• Tibial component loosening
• Patella problems
• Polyethylene insert wear
Instability after TKAInstability after TKA
• Ligament rupture
• Gradual laxity
• Undercorrection of bony deformity
• Cruciate retaining in a PCL deficient knee
• Flexion-extention gap
Infection after TKAInfection after TKA
• A catastrophic disaster
• Early or late
• Early contamination with late presentation
• Acute or chronic
• Metastatic infection
Workup of a septic TKAWorkup 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 optionsTreatment 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:Prevention of complications:before operationbefore operation
• Patient selection
• Operate or not, TKA V UTO
• Prehabilitation
• Timing of surgery
• Operative environment
• Instrumentation
• Selection of prosthesis
Prevention of complications:Prevention of complications:(during operation)(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 complicationsPrevention 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
ComplicationsComplications
• In conventional TKA
• In MIS TKA
• In Navigation TKA
• In Navigation + MIS TKA
• Bilateral simultaneous TKA
TKANK YOUTKANK YOU