Updated: 6/11/2021

TKA Wound Complications

0%
Topic
Review Topic
0
0
0%
0%
Flashcards
3
N/A
N/A
Questions
5
0
0
0%
0%
Evidence
4
0
0
0%
0%
Videos / Pods
6
0%
Techniques
2
Topic
Images
https://upload.orthobullets.com/topic/12752/images/f2.large.jpg
https://upload.orthobullets.com/topic/12752/images/f1.large.jpg
  • summary
    • TKA Wound Complications may occur as a result of patient underlying systemic factors, prior surgery to the knee, or direct trauma post-operatively. 
    • Diagnosis is made clinically with presence of incisional breakdown or dehiscence. 
    • Treatment depends on the size of the wound, thickness of the wound, and the limb vascular status.
  • Epidemiology
    • Risk factors
      • systemic factors
        • vascular disease
        • inflammatory arthritides such as rheumatoid arthritis
        • certain medications (immunosuppressives)
        • poor nutritional status
        • albumin <3.5g/dL
        • total lymphocyte count <1,500/uL
        • perioperative anemia
        • morbid obesity (BMI >40 kg/m^2)
      • local factors
        • previous incisions
          • skin bridges should be >5-6cm
          • avoid crossing previous skin incisions at an angle <60 degrees
          • use most lateral incision possible
        • knee deformity
        • skin adhesions
        • poor local blood supply
      • technique
        • large subcutaneous skin flaps
        • short incisions requiring vigorous skin traction
        • not preserving subcutaneous fat layer
        • long surgical time
        • long tourniquet time
      • postoperative
        • hematoma
        • infection
        • early (first 4 days) knee flexion beyond 40 degrees in a high risk knee
  • Presentation
    • History
      • multiply operated knee
      • prior infection
    • Symptoms
      • persistent knee pain
      • persistent drainage beyond the early postoperative period (7 days)
    • Physical exam
      • wound breakdown
      • erythema
      • warmth
      • drainage
      • peri-incisional eschar
  • Imaging
    • Radiographs
      • may help rule-out deep infection. looks for bone resorption
    • Bone scan
      • radionuclide studies if infection suspected but aspiration and serology not confirmatory
    • Angiography
      • if flow through sural arteries in question and gastrocnemius flap planned
  • Treatment
    • Nonoperative
      • local wound care +/- antibiotics
        • indications
          • may be appropriate for some small superficial wounds
          • patients who are not surgical candidates
    • Operative
      • debridement and coverage with rotational flap
        • indications
          • full-thickness necrosis
          • medial gastrocnemius rotational flap (medial sural artery): anterior and medial defects
          • lateral gastrocnemius rotational flap (lateral sural artery): lateral defects
Technique Guides (2)
Flashcards (3)
Cards
1 of 3
Questions (5)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(SBQ16HK.5) Which comorbidity is most significantly associated with the early surgical wound complications requiring surgical interventions following primary total knee arthroplasty?

QID: 211163
1

Type 2 diabetes mellitus

82%

(1329/1620)

2

Previous arthroscopic knee surgery

2%

(28/1620)

3

Post-operative aspirin DVT prophylaxis

0%

(3/1620)

4

Body mass index of 31 kg/m^2

14%

(230/1620)

5

Tourniquet use for 70 minutes

1%

(21/1620)

L 2 B

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(OBQ04.103) A 62-year-old female underwent a primary total knee arthroplasty of the left knee 10 days ago. She presents to clinic with skin necrosis of the midline incision. There is no deep infection present upon aspiration of the knee joint. She undergoes superficial irrigation and debridement and is left with exposed patellar tendon as shown in Figure A. What is the most appropriate next step in management?

QID: 1208
FIGURES:
1

Split thickness skin grafting

5%

(110/2243)

2

Twice daily wet-to-dry dressing changes with Dakin's solution until healing by secondary intention

1%

(29/2243)

3

Latissimus dorsi free flap transfer

1%

(32/2243)

4

Vacuum-assisted closure device until healing by secondary intention

7%

(149/2243)

5

Medial gastrocnemius muscle flap transfer and skin grafting

85%

(1916/2243)

L 2 D

Select Answer to see Preferred Response

Evidence (4)
VIDEOS & PODCASTS (6)
EXPERT COMMENTS (0)
Private Note