Knee Surgery pp 420-428 | Cite as

Soft Tissue Complications After Total Knee Arthroplasty

  • Fred D. Cushner
  • Susan Craig Scott
  • W. Norman Scott


Of paramount importance to a successful total knee arthroplasty (TKA) is successful wound healing. Unfortunately, this is not always possible, and thus the goals of rapid rehabilitation and patient mobilization are not always achieved. Wound failure can lead to prosthesis infection, numerous surgical procedures, as well as an extended hospitalization. The patient’s and surgeon’s expectations are not met and frustration can occur for all parties involved.


Total Knee Arthroplasty Free Flap Continuous Passive Motion Wound Problem Soft Tissue Complication 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Scapinelli R. Studies on the vasculature of the human knee. Acta Anat 1968; 70: 305–331.PubMedCrossRefGoogle Scholar
  2. 2.
    Craig SM. Soft tissue considerations in the failed total knee arthroplasty. In: Scott WN (ed). The Knee, vol 2. St. Louis: Mosby-Yearbook, 1994: 1279–1295.Google Scholar
  3. 3.
    Abbott LC, Carpenter WF. Surgical approaches to the knee joint. J Bone Joint Surg 1945; 27: 277–310.Google Scholar
  4. 4.
    Bjorkstrom S, Goldie IF. A study of the arterial supply of the patellae in the normal state, in chondromalacia patellae and in osteonecrosis. Acta Orthop Scand 1980; 51: 63–70.PubMedCrossRefGoogle Scholar
  5. 5.
    Waisbrod H, Treiman N. Intra-osseous venography in patellofemoral disorders: a preliminary report. J Bone Joint Surg 1980; 62B: 454–456.Google Scholar
  6. 6.
    Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987; 40: 113.PubMedCrossRefGoogle Scholar
  7. 7.
    Arey LB. Wound healing. Physiol Reu 1966; 16: 327.Google Scholar
  8. 8.
    Glenn F, Moore SW. The disruption of abdominal wounds. Surg Gynecol Obstet 1941; 72: 1041.Google Scholar
  9. 9.
    Heughan C, Chir B, Grislis G, Hunt JK. The effect of anemia on wound healing. Ann Surg 1974; 179: 163.PubMedCrossRefGoogle Scholar
  10. 10.
    Johnson DD, Eastwood DM. Lateral patellar release in knee arthroplasty: effect on wound healing. J Arthroplasty 1992; 7 (suppl): 407–431.Google Scholar
  11. 11.
    Archauer BM, Black KS, Litke DK. Transcutaneous p02 in flaps: a new method of survival prediction. Plast Reconst Surg 1980; 65: 738–745.CrossRefGoogle Scholar
  12. 12.
    Ecker ML, Lotke PA. Postoperative care of the total knee patient. Orthop Clin North Am 1989; 20: 55–62.Google Scholar
  13. 13.
    Dickhaut SC, DeLee JL, Pase CP. Nutritional statistics. Importance in predicting wound healing after amputation. J Bone Joint Surg 1984; 66A: 71–75.PubMedGoogle Scholar
  14. 14.
    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
  15. 15.
    Cruse PJ, Foord R. A five-year prospective study of 23,649 surgical wounds. Arch Surg 1973; 107: 206210.Google Scholar
  16. 16.
    Benowitz NL, Jacob P III. Daily intake of nicotine during cigarette smoking. Clin Pharmacol Ther 1984; 35: 494.CrossRefGoogle Scholar
  17. 17.
    Benowitz NL, Koyt F, Jacob P. Influence of nicotine on cardiovascular and hormone effects of cigarette smoking. Clin Pharmacol Ther 1984; 36: 74.Google Scholar
  18. 18.
    Benowitz NL, Kuyt F, Jacob P 3d, et al. Cotinine disposition and effects. Clin Pharmacol Ther 1983; 34: 664.CrossRefGoogle Scholar
  19. 19.
    Klein NE, Cox LU. Wound problems in total knee arthroplasty. In: Fu FH, Harner CD, Vince KG, et al (eds). Knee Surgery, vol 2. Baltimore: Williams and Wilkins, 1994: 1539–1552.Google Scholar
  20. 20.
    Green JP. Steroid therapy and wound healing in surgical patients. Br J Surg 1965; 52: 523–525.PubMedCrossRefGoogle Scholar
  21. 21.
    Wahl LM. Hormonal resolution of macrophage collage-nase activity. Biochem Biophys Res Commun 1977; 74: 838–845.PubMedCrossRefGoogle Scholar
  22. 22.
    Werb Z. Biochemical actions of glucocorticoids on macrophages in culture. J Exp Med 1978; 147 (6): 1695–1712.PubMedCrossRefGoogle Scholar
  23. 31:.
    Soft Tissue Complications After Total Knee Arthroplasty 427Google Scholar
  24. 23.
    Garner RW, Mowot AG, Hazleman BL. Wound healing after operations on patients with rheumatoid arthritis. J Bone Joint Surg 1973; 55B (1): 134–144.Google Scholar
  25. 24.
    Grogan TJ, Dores F, Rolling J, Amstutz HC. Deep sepsis following total knee arthroplasty. J Bone Joint Surg 1986; 68A (2): 226–234.Google Scholar
  26. 25.
    Dennis PA. Wound complications in total knee arthroplasty. Inst Course Lect 1997; 46: 165–169.Google Scholar
  27. 26.
    Gold DA, Scott SC, Scott WN. Soft tissue expansion prior to arthroplasty in the multiply operated knee-a new method of preventing catastrophic skin problems. J Arthroplasty 1996; 11 (5): 512–521.PubMedCrossRefGoogle Scholar
  28. 27.
    Santore RF, Kaufman D, Robbins AJ, Dabezies EJ. Tissue expansion prior to revision total knee arthroplasty. J Arthroplasty 1997; 12 (4): 475–478.PubMedCrossRefGoogle Scholar
  29. 28.
    Namba RS, Diao E. Tissue expansion for staged reim-plantation of infected total knee arthroplasty. J Arthroplasty 1997; 12 (4): 471–474.PubMedCrossRefGoogle Scholar
  30. 29.
    Riederman R, Noyes FR. Soft tissue skin expansion of contracted tissues prior to knee surgery. Am J Knee Surg 1991; 4 (4): 195–199.Google Scholar
  31. 30.
    Johnson DD. Midline or parapatellar incision for knee arthroplasty. A comparative study of wound inability. J Bone Joint Surg 1988; 70B (4): 656–658.Google Scholar
  32. 31.
    Johnson DD, Houshton TA, Redford P. Anterior midline or medial parapatellar incision for arthroplasty of the knee. A comparative study. J Bone Joint Surg 1986; 68B (5): 812–814.Google Scholar
  33. 32.
    Ecker ML, Lotke PA. Wound healing complications. In: Rand JA (ed). Total Knee Arthroplasty. New York: Raven Press, 1993: 403–407.Google Scholar
  34. 33.
    Windsor RE, Insall JN, Vince KE. Technical consideration of total knee arthroplasty after proximal tibial osteotomy. J Bone Joint Surg 1988; 70A: 547–555.PubMedGoogle Scholar
  35. 34.
    Casha JN. Suture reaction following skin closure with sub-cuticular polydionanone in total knee arthroplasty. J Arthroplasty 1996; 11 (7): 859–861.PubMedCrossRefGoogle Scholar
  36. 35.
    Rosenberg AG. Surgical technique of posterior cruciate sacrificing and preserving total knee arthroplasty. In: Rand JA (ed). Total Knee Arthroplasty. New York: Lippincott-Raven, 1993: 115.Google Scholar
  37. 36.
    Rothause KO. Plastic and reconstructive surgery. In: Insall JN (ed). Surgery of the Knee, vol 2. New York: Churchill-Livingstone, 1993: 1200–1201.Google Scholar
  38. 37.
    Johnson DD. The effect of continuous passive motion on wound healing and joint mobility after total knee arthroplasty. J Bone Joint Surg 1990; 78 (A): 421–426.Google Scholar
  39. 38.
    Yashar AA. Continuous passive motion with accelerated flexion after total knee arthroplasty. Clin Orthop 1997; 345: 38–43.Google Scholar
  40. 39.
    Faralli VJ, Lotke PA, Orenstein E. Blood loss after total knee replacement: effects of early motion. Paper presented at the 55th annual meeting of AAOS, February 1988.Google Scholar
  41. 40.
    Abdel-Salam A, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomized study. J Bone Joint Surg 1995; 77B (2): 250–253.Google Scholar
  42. 41.
    Holt BT, Parks NL, Ensh GA, Lawrence JM. Comparison of closed suction drainage and no drainage after primary total knee arthroplasty. Orthopaedics 1997; 20 (12): 1121–1124.Google Scholar
  43. 42.
    Crevoisier XM, Reber P, Noesberger B. Is suction drainage necessary after total joint arthroplasty? A prospective study. Arch Orthop Trauma Surg 1998; 117 (3): 121–124.CrossRefGoogle Scholar
  44. 43.
    Ovadin D, Luger E, Bickels J, Menachem A, Dekel S. Efficacy of closed wound drainage after total joint arthroplasty. A prospective randomized study. J Arthroplasty 1997; 12 (3): 317–321.CrossRefGoogle Scholar
  45. 44.
    Drinkwater CJ, Neil MJ. Optimal timing of wound drain removal following total joint arthroplasty. J Arthroplasty 1995; 10 (2): 185–189.PubMedCrossRefGoogle Scholar
  46. 45.
    Stulberg BN, Insall JN, Williams GW, Ghelman B. Deep vein thrombosis following total knee replacement. J Bone Joint Surg 1984; 66A (2): 194–201.PubMedGoogle Scholar
  47. 46.
    Levine MN, Gent M, Hirsh J, et al. Ardeparin (low molecular weight heparin) vs. graduated compression stockings for the prevention of venous thromboembolism. A randomized trial in patients undergoing knee surgery. Arch Intern Med 1996; 156: 851–856.Google Scholar
  48. 47.
    Leclerc JR, Geerts WN, DesJardins L, et al. Prevention of venous thromboembolism (WTE) after knee arthroplasty-a randomized double-blind trial comparing a low molecular-weight heparin fragment (Enoxaparin) to warfarin. Blood 1992; 84: 246a.Google Scholar
  49. 48.
    Spiro TE, Fitzgerald RH, Trowbridge AA, et al. Enoxaparin-a low molecular weight heparin and warafin for the prevention of venous thromboembolic disease after elective knee replacement surgery. Blood 1994; 84: 246a.Google Scholar
  50. 49.
    Weiss AP, Krackow KA. Persistent wound drainage after primary total knee arthroplasty. J Arthroplasty 1993; 8: 285–289.PubMedCrossRefGoogle Scholar
  51. 50.
    Bergstrom S, Krutson K, Lidgren L. Treatment of infected knee arthroplasty. Clin Orthop 1989; 245: 173–178.Google Scholar
  52. 51.
    Insall J, Aglietti P. A five to seven-year follow-up of unicondylar arthroplasty. J Bone Joint Surg 1980; 62A: 1329–1337.PubMedGoogle Scholar
  53. 52.
    Sculco TP. Local wound complications after total knee arthroplasty. In: Ranawat C (ed). Total Condylar Knee Arthroplasty: Technique, Results and Complications. New York: Springer-Verlag, 1985: 194–196.CrossRefGoogle Scholar
  54. 53.
    Hallock GG. Salvage of total knee arthroplasty with local fasciocutaneous flaps. J Bone Joint Surg 1990; 72 (B): 1236–1239.Google Scholar
  55. 54.
    Bergstrom S, Carlsson A, Relander M, Kuntson K, Lindgren L. Treatment of the exposed knee prosthesis. Acta Orthop Scand 1987; 58: 662–665.CrossRefGoogle Scholar
  56. 428.
    F.D. Cushner, S.C. Scott, and W.N. ScottGoogle Scholar
  57. 55.
    Eckhardt JJ, Lesavoy MA, Dubrow TJ, Wackyum PA. Exposed endo-prosthesis. Clin Orthop 1990; 251: 220229.Google Scholar
  58. 56.
    Hemphill CS, Ebert FR, Muench AG. The medial gastrocnemius muscle flap in the treatment of wound complications following total knee arthroplasty. Orthopaedics 1992; 15 (4): 477–480.Google Scholar
  59. 57.
    Peled IJ, Franki U, Wexler MR. Salvage of exposed knee prosthesis by gastrocnemius myocutaneous flap coverage. Orthopedics 1983; 6 (10): 1320–1322.Google Scholar
  60. 58.
    Salibian AH, Sanford HA. Salvage of an infected total knee prosthesis with medial and lateral gastrocnemius muscle flaps. J Bone Joint Surg 1983;65A(5):681684.Google Scholar
  61. 59.
    Gerwin M, Rothaus KU, Windsor RE, et al. Gastrocnemius muscle flap coverage of exposed or infected knee prosthesis. Clin Orthop 1993; 286: 64–70.PubMedGoogle Scholar
  62. 60.
    Markovich G, Dorr LD, Klein NE, McPherson EJ, Vince KG. Muscle flaps in knee arthroplasty. Clin Orthop 1995; 321: 122–130.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Fred D. Cushner
  • Susan Craig Scott
  • W. Norman Scott

There are no affiliations available

Personalised recommendations