Complication of total knee arthroplasty
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Synopsis
Causes / typical injury mechanism: Several complications may occur following total knee arthroplasty (TKA). Complications may be categorized as surgical complications, perioperative complications, or chronic complications. The evaluation of the painful TKA is complex and requires a detailed history and physical examination in combination with radiographs and possibly other tests to find the etiology. This summary is a general overview of the painful TKA and diagnostic steps. Complications include those listed below. See individual summaries for additional details.- Vascular injury
- Intraoperative fracture
- Peroneal nerve injury
- Medial collateral ligament injury
- Patellar maltracking
- Wound complication, wound healing complications
- Periprosthetic joint infection
- Arthrofibrosis
- Heterotopic ossification
- Aseptic loosening, osteolysis
- Global or midflexion instability
- Dislocation
- Metal hypersensitivity
- Polyethylene wear
Classic history and presentation: TKA is overall a successful surgical procedure for symptomatic knee degenerative disease with significant improvements in patients' quality of life. However, several complications following TKA have been described that differ in underlying etiology and presentation, ranging from continued pain and swelling to stiffness and instability, loosening, or infection. Up to 20% of patients remain unsatisfied with the outcome of TKA and may present with a painful TKA. Evaluation of the painful TKA is challenging and requires a systematic approach.
Risk factors:
- Previous knee surgeries, possible revision surgeries
- Wound healing complications
- Increased body mass index (BMI)
- Female sex
- Middle-aged
- Diabetes mellitus
- Inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, gout, pseudogout)
Codes
ICD10CM:T85.9XXA – Unspecified complication of internal prosthetic device, implant and graft, initial encounter
SNOMEDCT:
309767001 – Pain due to knee joint prosthesis
433084008 – Infection of total knee joint prosthesis
69260008 – Complication of internal prosthetic device
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Aseptic loosening
- Prosthetic joint infection
- Ligament instability
- Periprosthetic fracture
- Arthrofibrosis
- Patellofemoral maltracking
- Patellar clunk
- Osteolysis
- Metal hypersensitivity
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References
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Last Reviewed:11/15/2021
Last Updated:04/26/2022
Last Updated:04/26/2022
Complication of total knee arthroplasty