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 diabetes mellitus vascular disease inflammatory arthritides such as rheumatoid arthritis certain medications (immunosuppressives) tobacco use 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 Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA Revision Orthobullets Team Recon - TKA Patellar Prosthesis Loosening Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA - Parapatellar Approach Derek T. Bernstein Stephen Incavo Recon - TKA Patellar Maltracking
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK 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 Type & Select Correct Answer 1 Type 2 diabetes mellitus 82% (1727/2105) 2 Previous arthroscopic knee surgery 2% (36/2105) 3 Post-operative aspirin DVT prophylaxis 0% (7/2105) 4 Body mass index of 31 kg/m^2 14% (297/2105) 5 Tourniquet use for 70 minutes 1% (25/2105) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic 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: A Type & Select Correct Answer 1 Split thickness skin grafting 5% (130/2555) 2 Twice daily wet-to-dry dressing changes with Dakin's solution until healing by secondary intention 1% (35/2555) 3 Latissimus dorsi free flap transfer 2% (39/2555) 4 Vacuum-assisted closure device until healing by secondary intention 7% (173/2555) 5 Medial gastrocnemius muscle flap transfer and skin grafting 85% (2168/2555) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
All Videos (6) Podcasts (0) Login to View Community Videos Login to View Community Videos 2019 Orthopaedic Summit Evolving Techniques Evolving Technique: 61-Year-Old Pickleball Player With Rheumatoid Arthritis: Defining The High Wound Risk Patient - How I Treat It - Soft Tissue Negative Pressure - John Cooper, MD H. John Cooper Recon - TKA Wound Complications C 11/20/2020 49 views 0.0 (0) Login to View Community Videos Login to View Community Videos 2019 Orthopaedic Summit Evolving Techniques Rebuttal: Debate: 75-Year-Old Status Post Total Knee Arthroplasty 3 Months Ago With Consistent Drainage With Immunosuppressed Coming From The Wound - Ed McPherson, MD Edward McPherson Recon - TKA Wound Complications C 11/14/2020 40 views 0.0 (0) Login to View Community Videos Login to View Community Videos 2019 Orthopaedic Summit Evolving Techniques Single Stage Exchange Can Work For You: Let Me Teach You The Tricks - Edward McPherson, MD Edward McPherson Recon - TKA Wound Complications C 11/14/2020 52 views 0.0 (0) See More See Less