1. Complications of Total Knee Arthroplasty H.Makhmalbaf MD Consultant Orthopaedic & Knee surgeon Mashad University

2. Prevention of complications Preoperative causes Perioperative causes Intraoperative causes Postoperative complications

3. Preoperative causes Patient selection Culture,BMI, habits, environment Patient’s motivation Deformity : articular, extraarticular Ligament laxity or imbalance Previous surgery Range of movement

4. Perioperative causes Operation day, session, Time of surgery Surgeon preparation Too busy list Operating room situation, help, assistant Patient positioning Anesthesia,

5. Intraoperative causes Surgical technique Prosthetic design Prep & drape, leg holder Operative room condition, laminar flow Use of turniquet, irrigation, drains Wound closure,Bandage & dressings Antibiotics & DVT prophylaxis

7. PCL retention

8. Postoperative causes Patients management Physiotherapy,CPM machine Rehabilitation Wound care Range of movement

9. 6yrs post op previous osteotomy 6yrs post op previous osteotomy

10. Complications of TKA Medical & mechanical complications Prosthetic design related Posterior stabilized or cruciate retaining Patella resurfacing

11. Patellofemoral complications Account for as much as 50% of complications requiring re-operation Wear of an unresurfaced patella Maltracking Patella fracture Prosthetic loosening Osteonecrosis & prosthetic wear

12. Stiffness before & after TKA Fixed flexion deformity Limitation of flexion or both Overall ROM before surgery Bone stock poor Deformity corrected during surgery Developed after surgery Poor pain control

13. Treatment of stiffness During arthroplasty After operation Physiotherapy MUA Arthroscopy & release arthrofibrosis

14. Reoperation after TKA Femoral component loosening Fractured femoral component Tibial component loosening Patella problems Polyethylene insert wear

15. Instability after TKA Ligament rupture Gradual laxity Undercorrection of bony deformity Cruciate retaining in a PCL deficient knee Flexion-extention gap

20. Infection after TKA A catastrophic disaster Early or late Early contamination with late presentation Acute or chronic Metastatic infection

21. Workup of a septic TKA Status of the wound The bone cement interface The organism an it’s sensitivity to AB The medical status of the patient Search for another source of infection ESR & CRP Knee aspiration for culture & cell count

22. Treatment options Closed treatment Open synovectomy, debridement, & insert exchange Primary prosthetic exchange Delayed prosthetic exchange Resection arthroplasty Knee arthrodesis, & Amputation

23. Summary:( Richard Scott) It is a devastating complication Prevention, treatment unnecessary Incidence of early primary TKA 0.5% Late infection 1% Good fortune & implementation of measure Late infection in RA, UTI, foot ulcers, infected dentition

24. Prevention of complications: before operation Patient selection Operate or not, TKA V UTO Prehabilitation Timing of surgery Operative environment Instrumentation Selection of prosthesis

25. Prevention of complications: (during operation) Soft tissue balance Treat bone defects, cement v bone graft Flexion extension gap Bone cuts femur & tibia, limitations Slope: ant. Post.& mediolateral in tibia Fractures, Tibia & Femur

26. Prevention of complications: Rotation & flex extension of femoral comp. References for femur & tibia rotation Correct size, no notching Small mistakes multiply in TKA Protect ligaments Prevent fracture

27. Complications In conventional TKA In MIS TKA In Navigation TKA In Navigation + MIS TKA Bilateral simultaneous TKA

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