Advertisement

Wound Complications in Total Knee Arthroplasty

  • Douglas A. Dennis
Chapter

Abstract

Primary wound healing is critical for the success of any total knee arthroplasty (TKA). Any delay in wound healing risks infection and arthroplasty failure (1). Prevention of soft-tissue problems through the proper selection of skin incision, an understanding of vascular anatomy and patient risk factors, and prompt management should wound problems arise, is imperative to achieve desired results.

Keywords

Wound Healing Total Knee Arthroplasty Wound Complication Lateral Retinacular Release Genicular Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1. Poss R, Thornhill TS, Ewald FC, et al: Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop 1984;182:117-126.Google Scholar
  2. Klein NE, Cox CV: Wound problems in total knee arthroplasty. In Fu FH, Hamer CD, Vince KG, et al (eds): Knee Surgery. Baltimore, MD, Williams & Wilkins, 1994, vol 2, pp 1539-1552.Google Scholar
  3. 3. Müller W (ed): The Knee: Form, Function and Ligament Reconstruction. Berlin, Germany, Springer-Verlag, 1983, pp 158-167.Google Scholar
  4. 4. Scapinelli R: Studies on the vasculature of the human knee joint. Acta Anat 1968;70:305-331.Google Scholar
  5. 5. Craig SM: Soft tissue considerations in the failed total knee arthroplasty. In Scott WN (ed): The Knee. St. Louis, MO, Mosby-Year Book, 1994, vol 2, pp 1279-1295.Google Scholar
  6. 6. Abbott LC, Carpenter WF: Surgical approaches to the knee joint. J Bone Joint Surg 1945;27:277-310.Google Scholar
  7. 7. Björkström S, Goldie IF: A study of the arterial supply of the patella in the normal state, in chondromalacia patellae and in osteoarthrosis. Acta Orthop Scand 1980;51:63-70.Google Scholar
  8. 8. Waisbrod H, Treiman N: Intra-osseous venography in patellofemoral disorders: A preliminary report. J Bone Joint Surg 1980;62B:454-456.Google Scholar
  9. 9. Johnson DP: Midline or parapatellar incision for knee arthroplasty: A comparative study of wound viability. J Bone Joint Surg 1988;70B:656-658.Google Scholar
  10. 10. Johnson DP, Houghton TA, Radford P: Anterior midline or medial parapatellar incision for arthroplasty of the knee: A comparative study. J Bone Joint Surg 1986;68B:812-814.Google Scholar
  11. 11. Ecker ML, Lotke PA: Wound healing complications. In Rand JA (ed): Total Knee Arthroplasty. New York, NY, Raven Press, 1993, pp 403-407.Google Scholar
  12. 12. Windsor RE, Insall JN, Vince KG: Technical consideration of total knee arthroplasty after proximal tibial osteotomy. J Bone Joint Surg 1988;70A:547-555.Google Scholar
  13. 13. Mahomed N, McKee N, Solomon P, et al: Soft-tissue expansion before total knee arthroplasty in arthrodesed joints: A report of two cases. J Bone Joint Surg 1994;76B:88-90.Google Scholar
  14. 14. Argenta LC, Marks MW, Pasyk KA: Advances in tissue expansion. Clin Plast Surg 1985;12:159-171.Google Scholar
  15. 15. Manders EK, Oaks TE, Au VK, et al: Soft-tissue expansion in the lower extremities. Plast Reconstr Surg 1988;81:208-219.Google Scholar
  16. 16. Manders EK, Schenden MJ, Furrey JA, et al: Soft-tissue expansion: Concepts and complications. Plast Reconstr Surg 1984;74:493-507.Google Scholar
  17. 17. Radovan C: Tissue expansion in soft-tissue reconstruction. Plast Reconstr Surg 1984;74:482-492.Google Scholar
  18. 18. Riederman R, Noyes FR: Soft tissue skin expansion of contracted tissues prior to knee surgery. Am J Knee Surg 1991;4:195-198.Google Scholar
  19. 19. Clayton ML, Thirupathi R: Patellar complications after total condylar arthroplasty. Clin Orthop 1982;170:152-155.Google Scholar
  20. 20. Johnson DP, Eastwood DM: Lateral patellar release in knee arthroplasty: Effect on wound healing. J Arthroplasty 1992; 7(suppl):427-431.Google Scholar
  21. 21. Kayler DE, Lyttle D: Surgical interruption of patellar blood supply by total knee arthroplasty. Clin Orthop 1988; 229:221-227.Google Scholar
  22. 22. Scuderi G, Scharf SC, Meltzer LP, et al: The relationship of lateral release to patella viability in total knee arthroplasty. J Arthroplasty 1987;2:209-214.Google Scholar
  23. 23. Craig SM: Soft tissue considerations. In Scott WN (ed): Total Knee Revision Arthroplasty. Orlando, FL, Grune & Stratton, 1987, pp 99-112.Google Scholar
  24. 24. Green JP: Steroid therapy and wound healing in surgical patients. Br J Surg 1965;52:523-525.Google Scholar
  25. 25. McNamara JJ, Lamborn PJ, Mills D, et al: Effect of short-term pharmacologic doses of adrenocorticosteroid therapy on wound healing. Ann Surg 1969;170:199-202.Google Scholar
  26. 26. Nelson CL: Prevention of sepsis. Clin Orthop 1987; 222:66-72.Google Scholar
  27. 27. Petty W, Bryan RS, Coventry MB, Peterson LF: Infection after total knee arthroplasty. Orthop Clin North Am 1975; 6:1005-1014.Google Scholar
  28. 28. Sculco TP: Local wound complications after total knee arthroplasty. In Ranawat CS (ed): Total Condylar Knee Arthroplasty:Technique, Results, and Complications. New York, NY, Springer-Verlag, 1985, pp 194-196.Google Scholar
  29. 29. Wahl LM: Hormonal regulation of macrophage collagenase activity. Biochem Biophys Res Commun 1977; 74:838-845.Google Scholar
  30. 30. Werb Z: Biochemical actions of glucocorticoids on macrophages in culture: Specific inhibition of elastase, collagenase, and plasminogen activator secretion and effects on other metabolic functions. J Exp Med 1978; 147:1695-1712.Google Scholar
  31. 31. D' Ambrosia RD, Shoji H, Heater R: Secondarily infected total joint replacements by hematogenous spread. J Bone Joint Surg 1976;58A:450-453.Google Scholar
  32. 32. Garner RW, Mowat AG, Hazleman BL: Wound healing after operations on patients with rheumatoid arthritis. J Bone Joint Surg 1973;55B:134-144.Google Scholar
  33. 33. Grogan TJ, Dorey F, Rollins J, et al: Deep sepsis following total knee arthroplasty: Ten-year experience at the University of California at Los Angeles Medical Center. J Bone Joint Surg 1986;68A:226-234.Google Scholar
  34. 34. Thomas BJ, Moreland JR, Amstutz HC: Infection after total joint arthroplasty from distal extremity sepsis. Clin Orthop 1983;181:121-125.Google Scholar
  35. 35. Wilson MG, Kelley K, Thornhill TS: Infection as a complication of total knee-replacement arthroplasty: Risk factors and treatment in sixty-seven cases. J Bone Joint Surg 1990; 72A:878-883.Google Scholar
  36. 36. Wong RY, Lotke PA, Ecker ML: Factors influencing wound healing after total knee arthroplasty. Orthop Trans 1986; 10:497.Google Scholar
  37. 37. Cruse PJ, Foord R: A five-year prospective study of 23,649 surgical wounds. Arch Surg 1973;107:206-210.Google Scholar
  38. 38. Ecker ML, Lotke PA: Postoperative care of the total knee patient. Orthop Clin North Am 1989;20:55-62.Google Scholar
  39. 39. Dickhaut SC, DeLee JC, Page CP: Nutritional status: Importance in predicting wound-healing after amputation. J Bone Joint Surg 1984;66A:71-75.Google Scholar
  40. 40. Craig S, Rees TD: The effects of smoking on experimental skin flaps in hamsters. Plast Reconstr Surg 1985; 75:842-846.Google Scholar
  41. 41. Benowitz NL, Kuyt F, Jacob P III: Influence of nicotine on cardiovascular and hormonal effects of cigarette smoking. Clin Pharmacol Ther 1984;36:74-81.Google Scholar
  42. 42. Mosely LH, Finseth F, Goody M: Nicotine and its effect on wound healing. Plast Reconstr Surg 1978;61:570-575.Google Scholar
  43. 43. Rees TD, Liverett DM, Guy CL: The effect of cigarette smoking on skin-flap survival in the face lift patient. Plast Reconstr Surg 1984;73:911-915.Google Scholar
  44. 44. Kaufman T, Eichenlaub EH, Levin M, et al: Tobacco smoking: Impairment of experimental flap survival. Ann Plast Surg 1984;13:468-472.Google Scholar
  45. 45. Goodson WH III, Hunt TK: Studies of wound healing in experimental diabetes mellitus. J Surg Res 1977; 22:221-227.Google Scholar
  46. 46. Goodson WH III, Hunt TK: Wound healing and the diabetic patient. Surg Gynecol Obstet 1979;149:600-608.Google Scholar
  47. 47. McMurry JF Jr: Wound healing with diabetes mellitus: Better glucose control for better wound healing in diabetes. Surg Clin North Am 1984;64:769-778.Google Scholar
  48. 48. McGrath MH: The effect of prostaglandin inhibitors on wound contraction and the myofibroblast. Plast Reconstr Surg 1982;69:74-85.Google Scholar
  49. 49. Bridges SL Jr, Lopez Mendez A, Tracy I, et al: Should methotrexate be discontinued prior to total joint arthroplasty in rheumatoid arthritis patients? Arthritis Rheum 1989; 32(suppl 4):543.Google Scholar
  50. 50. Kasden ML, June L: Postoperative results of rheumatoid arthritis patients on methotrexate at the time of reconstructive surgery of the hand. Orthopedics 1993;16:1233-1235.Google Scholar
  51. 51. Perhala RS, Wilke WS, Clough JD, et al: Local infectious complications following large joint replacement in rheumatoid arthritis patients treated with emthotrexate versus those not treated with methotrexate. Arthritis Rheum 1991; 34:146-152.Google Scholar
  52. 52. Achauer BM, Black KS, Litke DK: Transcutaneous PO, in flaps: A new method of survival prediction. Plast Reconstr Surg 1980;65:738-745.Google Scholar
  53. 53. Goletz TH, Henry JH: Continuous passive motion after total knee arthroplasty. South Med J 1986;79:1116-1120.Google Scholar
  54. 54. Johnson DP: The effect of continuous passive motion on wound-healing and joint mobility after knee arthroplasty. J Bone Joint Surg 1990;72A:421-426.Google Scholar
  55. 55. Weiss AP, Krackow KA: Persistent wound drainage after primary total knee arthroplasty. J Arthroplasty 1993; 8:285-289.Google Scholar
  56. 56. Bengtson S, Knutson K, Lidgren L: Treatment of infected knee arthroplasty. Clin Orthop 1989;245:173-178.Google Scholar
  57. 57. Insall J, Aglietti P: A five to seven-year follow-up of unicondylar arthroplasty. J Bone Joint Surg 1980; 62A: 1329-1337.Google Scholar
  58. 58. Hallock GG: Salvage of total knee arthroplasty with local fasciocutaneous flaps. J Bone Joint Surg 1990; 72A: 1236-1239.Google Scholar
  59. 59. Lewis VL Jr, Mossie RD, Stulberg DS, et al: The fasciocutaneous flap: A conservative approach to the exposed knee joint. Plast Reconstr Surg 1990;85:252-257.Google Scholar
  60. 60. Lian G, Cracchiolo A III, Lesavoy M: Treatment of major wound necrosis following total knee arthroplasty. J Arthroplasty 1989;4(suppl):S23-S32.Google Scholar
  61. 61. Bengtson S, Carlsson A, Relander M, et al: Treatment of the exposed knee prosthesis. Acta Orthop Scand 1987; 58:662-665.Google Scholar
  62. 62. Eckardt JJ, Lesavoy MA, Dubrow Ti, et al: Exposed endoprosthesis: Management protocol using muscle and myocutaneous flap coverage. Clin Orthop 1990;251:220-229.Google Scholar
  63. 63. Greenberg B, LaRosa D, Lotke PA, et al: Salvage of jeopardized total-knee prosthesis: The role of the gastrocnemius muscle flap. Plast Reconstr Surg 1989;83:85-89;97-99.Google Scholar
  64. 64. Hemphill ES, Ebert FR, Muench AG: The medial gastrocnemius muscle flap in the treatment of wound complications following total knee arthroplasty. Orthopedics 1992; 15:477-480.Google Scholar
  65. 65. Salibian AH, Anzel SH: Salvage of an infected total knee prosthesis with medial and lateral gastrocnemius muscle flaps: A case report. J Bone Joint Surg 1983;65A:681-684.Google Scholar
  66. 66. Sanders R, O'Neill T: The gastrocnemius myocutaneous flap used as a cover for the exposed knee prosthesis. J Bone Joint Surg 1981;63B:383-386.Google Scholar
  67. 67. Gerwin M, Rothaus KO, Windsor RE, et al: Gastrocnemius muscle flap coverage of exposed or infected knee prostheses. Clin Orthop 1993;286:64-70.Google Scholar
  68. 68. Gordon L, Levinsohn DG: Versatility of the latissimus and serratus anterior muscle transplants in providing cover for exposed hardware and endoprostheses. Orthop Trans 1992; 16:68.Google Scholar
  69. 69. Insall J, Scott WN, Ranawat CS: The total condylar knee prosthesis: A report of two hundred and twenty cases. J Bone Joint Surg 1979;61A:173-180.Google Scholar

Copyright information

© Springer-Verlag Wien 2001

Authors and Affiliations

  • Douglas A. Dennis
    • 1
  1. 1.Rose Musculoskeletal Research LaboratoryColorado School of MinesDenver

Personalised recommendations