Wound Healing Problems in Total Knee Arthroplasty

Abstract

It is important to avoid underestimating the significance of wound complications following total knee arthroplasty (TKA). Expedient and aggressive care is recommended. Understanding the blood supply to the skin around the knee and measures to prevent wound complications are fundamental to preventing wound problems. A detailed patient history and physical examination will identify high-risk patients and any modifiable risk factors. Operative techniques such as raising full-thickness skin flaps and judicious placement of skin incisions in the presence of pre-existing scars can greatly reduce the incidence of wound problems. The first step in treating wound problems is recognizing when a problem is present and knowing when a minor problem can turn into a major one. Superficial infections or stitch abscesses can be treated with conservative treatment. However, the surgeon should have a low threshold to revert to surgical management if drainage persists. Skin necrosis or non-viable skin must be excised in the operating room, and the presence of a deep infection must be diagnosed by joint aspiration. The appropriate course of action in dealing with deep infection is dependent on the duration elapsed since the index procedure. The ability to perform a medial gastrocnemius muscle flap and skin graft is an invaluable skill in complex cases where primary wound closure cannot be achieved. Meticulous attention to detail during surgery and aggressive surgical treatment of wound complications can be the difference in saving the knee.

Acute Wound Complications After Total Knee Arthroplasty: Prevention and Management

“…Alternatively, the preoperative use of soft-tissue expanders may address skin that is severely adherent. 27,28 The techniques of soft-tissue expansion, as well as additional prophylactic and salvage soft-tissue transfers about the knee, are beyond the scope of this article. 26,28…”

Assuring the happy total knee replacement patient

“…Understanding the blood supply to the skin around the knee is fundamental in order to prevent wound problems. 30 Failure to obtain meticulous closure can result in the development of subcutaneous hematoma. The first step in treating such a wound is to recognise when a problem is present, as well as to know when a minor problem can turn into a major one.…”

“…In summary, wound management associated with TKR requires expedient and aggressive care. 30 The finer points of the operation. The surgeon must have intimate knowledge of both the instruments and implants they are using, which is helped by experience and the volume of surgeries performed.…”

Retalhos de rotação para cobertura após artroplastia total de joelho

“…, 5 - 7 , 11 , 13 - 16 In a literature review, we found variable results. Some series show good results, healing the infection with satisfactory cutaneous coverage of the knee; others show bad results with loss of retail, stiffness and pain in the knee and persistence of infection, which can lead to treatment failure and indication for amputation 11 …”

“…Problems with wound healing after total knee arthroplasty reach 20% of cases in some series; 9 , 10 however, wound dehiscence with total exposure of the prosthesis without the possibility of primary closure or secondary healing is very rare, and there are few publications that describe its treatment 5 7 , 11 - 15 …”