Complications of Total Knee Arthroplasty: Standardized List and Definitions of The Knee Society
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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.
We developed a standardized list and definitions of complications and adverse events associated with TKA.
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?”
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.
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.
KeywordsKnee Society Score Periprosthetic Joint Infection Public Reporting Oxford Knee Score Standardize List
The authors thank John Garfi, MS, EMT, Lahey Clinic Medical Center, who assisted with the preparation of the manuscript, and Mario Moric, MS, Rush University Medical Center, who assisted with the statistical evaluation.
- 1.Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMedGoogle Scholar
- 2.Centers for Disease Control and Prevention. CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care setting. January 1, 2012. Available at: http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf. Accessed June 25, 2012.
- 11.Hensyl WR, ed. Stedman’s Medical Dictionary. 25th ed. Baltimore, MD: Lippincott Williams & Wilkins; 1990:336.Google Scholar
- 14.Iorio R, Robb WJ, Healy WL, Berry DJ, Hozack WJ, Kyle RF, Lewallen DG, Trousdale RT, Jiranek WA, Stamos VP, Parsley BS. Orthopaedic surgeon workforce and volume assessment for total hip and knee replacement in the United States: preparing for an epidemic. J Bone Joint Surg Am. 2008;90:1598–1605.PubMedCrossRefGoogle Scholar
- 16.Knee Society. Bylaws. 2012. Available at: http://www.aahks.org/about/AAHKSBylaws.pdf. Accessed April 4, 2012.
- 19.Losina E, Walensky RP, Kessler CL, Emrani PS, Reichmann WM, Wright EA, Holt HL, Solomon DH, Yelin E, Paltiel AD, Katz JN. Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med. 2009;169:1102–1103, discussion 1121–1122.CrossRefGoogle Scholar
- 22.Parvizi J, Zmistowiski BS, Berbari EF, Baver TW, Spinger BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG. New definition for periprosthetic joint infection (from the work group of the Musculoskeletal Infection Society). Clin Orthop Relat Res. 2011;469:2992–2994.PubMedCrossRefGoogle Scholar
- 28.Watkins-Castillo S. Orthopaedic Practice in the US 2004–2005. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2004:1–4.Google Scholar