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Updated: Nov 8 2022

TKA Wound Complications

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  • 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
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