, Volume 471, Issue 1, pp 215-220
Date: 19 Jul 2012

Complications of Total Knee Arthroplasty: Standardized List and Definitions of The Knee Society

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Abstract

Background

Despite the importance of complications in evaluating patient outcomes after TKA, definitions of TKA complications are not standardized. Different investigators report different complications with different definitions when reporting outcomes of TKA.

Questions/purposes

We developed a standardized list and definitions of complications and adverse events associated with TKA.

Methods

In 2009, The Knee Society appointed a TKA Complications Workgroup that surveyed the orthopaedic literature and proposed a list of TKA complications and adverse events with definitions. An expert opinion survey of members of The Knee Society was used to test the applicability and reasonableness of the proposed TKA complications. For each complication, members of The Knee Society were asked “Do you agree with the inclusion of this complication as among the minimum necessary for reporting outcomes of knee arthroplasty?” and “Do you agree with this definition?”

Results

One hundred two clinical members (100%) of The Knee Society responded to the survey. All proposed complications and definitions were endorsed by the members, and 678 suggestions were incorporated into the final work product. The 22 TKA complications and adverse events include bleeding, wound complication, thromboembolic disease, neural deficit, vascular injury, medial collateral ligament injury, instability, malalignment, stiffness, deep joint infection, fracture, extensor mechanism disruption, patellofemoral dislocation, tibiofemoral dislocation, bearing surface wear, osteolysis, implant loosening, implant fracture/tibial insert dissociation, reoperation, revision, readmission, and death.

Conclusions

We identified 22 complications and adverse events that we believe are important for reporting outcomes of TKA. Acceptance and utilization of these standardized TKA complications may improve evaluation and reporting of TKA outcomes.

Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. One of the authors (WLH) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of $100,000, from DePuy Orthopaedics Inc (Warsaw, IN, USA). One of the authors (CJDV) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of $10,000, from Biomet Inc (Warsaw, IN, USA), less than $10,000 from ConvaTec Inc (Skillman, NJ, USA), and in excess of $10,000 from Smith & Nephew Inc (Memphis, TN, USA); receives research support from Smith & Nephew and Stryker Orthopaedics (Mahwah, NJ, USA); and serves on the Scientific Advisory Board and owns stock/options for CD Diagnostics Inc (Wynnewood, PA, USA). One of the authors (RI) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount less than $10,000, from Cadence Pharmaceuticals (San Diego, CA, USA). One of the authors (KRB) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of $100,000 from Biomet. One of the authors (FDC) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of $100,000 from Smith & Nephew and Salient Surgical Technologies Inc (Portsmouth, NH, USA), Angiotech Pharmaceuticals Inc (Vancouver, Canada), and Jantzen International Ltd (Elk Grove Village, IL, USA). One of the authors (DFD) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of $100,000 from DePuy. One of the authors (JHL) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of $100,000 from Zimmer Inc (Warsaw, IN, USA), MAKO Surgical Corp (Ft Lauderdale, FL, USA), Healthpoint Capital (New York, NY, USA), and CD Diagnostics.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
This work was primarily performed at Lahey Clinic, Burlington, MA, USA.