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

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

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.

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References

  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.

    PubMed  CAS  Google 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.

  3. Conaghan PG, Emerton M, Tennant A. Internal construct validity of the Oxford Knee Scale: evidence from Rasch measurement. Arthritis Rheum. 2007;57:1363–1367.

    Article  PubMed  Google Scholar 

  4. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.

    Article  PubMed  Google Scholar 

  5. Dixon MC, Brown RR, Parsch D, Scott RD. Modular fixed-bearing total knee arthroplasty with retention of the posterior cruciate ligament. J Bone Joint Surg Am. 2005;87:598–603.

    Article  PubMed  Google Scholar 

  6. Dunbar MJ, Robertsson O, Ryd L, Lidgren L. Appropriate questionnaires for total knee arthroplasty: results of a survey of 3600 patients from the Swedish Knee Arthroplasty Registry. J Bone Joint Surg Br. 2001;83:339–344.

    Article  PubMed  CAS  Google Scholar 

  7. Fehring T, Odum S, Troyer J, Iorio R. Joint replacement access in 2016: a supply side crisis. J Arthroplasty. 2010;25:1175–1181.

    Article  PubMed  Google Scholar 

  8. Fitzsimmons SE, Vazquez EA, Bronson MJ. How to treat the stiff total knee arthroplasty? A systematic review. Clin Orthop Relat Res. 2010;468:1096–1106.

    Article  PubMed  Google Scholar 

  9. Goldhahn S, Sawaguchi T, Audige L, Mund R, Hanson B, Bhandari M, Goldhahn J. Complication reporting in orthopaedic trials: a systematic review of randomized controlled trials. J Bone Joint Surg Am. 2009;91:1847–1853.

    Article  PubMed  CAS  Google Scholar 

  10. Healy WL, Rana A, Iorio R. Hospital economics of primary total knee arthroplasty at a teaching hospital. Clin Orthop Relat Res. 2011;469:87–94.

    Article  PubMed  Google Scholar 

  11. Hensyl WR, ed. Stedman’s Medical Dictionary. 25th ed. Baltimore, MD: Lippincott Williams & Wilkins; 1990:336.

  12. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.

    PubMed  Google Scholar 

  13. Insall JN, Ranawat CS, Aglietti P, Shine J. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am. 1976;58:754–765.

    PubMed  CAS  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.

    Article  PubMed  Google Scholar 

  15. Kelly MA, Clarke HD. Long-term results of posterior cruciate-substituting total knee arthroplasty. Clin Orthop Relat Res. 2002;404:51–57.

    Article  PubMed  Google Scholar 

  16. Knee Society. Bylaws. 2012. Available at: http://www.aahks.org/about/AAHKSBylaws.pdf. Accessed April 4, 2012.

  17. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.

    Article  PubMed  Google Scholar 

  18. Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009;467:2606–2612.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  20. McHorney CA, Haley SM, Ware JE Jr. Evaluation of the MOS SF-36 Physical Functioning Scale (PF-10): II. Comparison of relative precision using Likert and Rasch scoring methods. J Clin Epidemiol. 1997;50:451–461.

    Article  PubMed  CAS  Google Scholar 

  21. Noble PC, Scuderi GR, Brekke AC, Sikorskii A, Benjamin JB, Lonner JH, Chadha P, Daylamani DA, Scott WN, Bourne RB. Development of a new Knee Society Scoring System. Clin Orthop Relat Res. 2012;470:20–32.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  23. Ries MD, Philbin EF, Groff GD, Sheesley KA, Richman JA, Lynch F Jr. Improvement in cardiovascular fitness after total knee arthroplasty. J Bone Joint Surg Am. 1996;78:1696–1701.

    PubMed  CAS  Google Scholar 

  24. Robertsson O, Dunbar MJ. Patient satisfaction compared with general health and disease-specific questionnaires in knee arthroplasty patients. J Arthroplasty. 2001;16:476–482.

    Article  PubMed  CAS  Google Scholar 

  25. Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN. The new Knee Society Knee Scoring System. Clin Orthop Relat Res. 2012;470:3–19.

    Article  PubMed  Google Scholar 

  26. Soohoo NF, Zingmond DS, Lieberman JR, Ko CY. Optimal timeframe for reporting short-term complication rates after total knee arthroplasty. J Arthroplasty. 2006;21:705–711.

    Article  PubMed  Google Scholar 

  27. Veen SJ, Steenbruggen J, Roukema J. Classifying surgical complications: a critical appraisal. Arch Surg. 2005;140:1078–1083.

    Article  PubMed  Google Scholar 

  28. Watkins-Castillo S. Orthopaedic Practice in the US 2004–2005. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2004:1–4.

    Google Scholar 

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA, 01805, USA

    William L. Healy MD & Richard Iorio MD

  2. Rush University Medical Center, Chicago, IL, USA

    Craig J. Della Valle MD

  3. Joint Implant Surgeons, Inc, New Albany, OH, USA

    Keith R. Berend MD

  4. Insall Scott Kelly Institute, New York, NY, USA

    Fred D. Cushner MD

  5. Towson Orthopaedic Associates, Towson, MD, USA

    David F. Dalury MD

  6. Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA

    Jess H. Lonner MD

Authors
  1. William L. Healy MD
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  2. Craig J. Della Valle MD
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  3. Richard Iorio MD
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  4. Keith R. Berend MD
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  5. Fred D. Cushner MD
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  6. David F. Dalury MD
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  7. Jess H. Lonner MD
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Corresponding author

Correspondence to William L. Healy MD.

Additional information

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.

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Healy, W.L., Della Valle, C.J., Iorio, R. et al. Complications of Total Knee Arthroplasty: Standardized List and Definitions of The Knee Society. Clin Orthop Relat Res 471, 215–220 (2013). https://doi.org/10.1007/s11999-012-2489-y

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  • DOI: https://doi.org/10.1007/s11999-012-2489-y

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