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Risks of Total Knee Replacement

Dr. Ashutosh P Mavalankar

The following is a list of possible risks and potential complications of total knee replacement surgery. However, the most common complications are not directly related to the knee, and usually do not affect the result of the operations.

  1. complications: With modern anaesthetic techniques, these are minimized to a great extent.
  2. Thrombophlebitis (Blood Clots): Thrombophlebitis, sometimes called deep venous thrombosis (DVT), can occur after any operation, but is more likely to occur following surgery on the hip, pelvis, or knee. DVT occurs when blood clots form in the large veins of the leg which may cause the leg to swell and become warm to the touch and painful. If the blood clots in the veins break apart, they can travel to the lung where they lodge in the capillaries and cut off the blood supply to a portion of the lung. This is called pulmonary embolism. Risk of this condition in Indian patients is minimal and it is further reduced by early mobilization of the patient after surgery. In some patients, medications that thin the blood and prevent blood clots from forming are used.
  3. Infection: The chance of contracting an infection following artificial knee replacement is probably around one percent. Infection can occur following any type of surgery. In order to minimize the chances of infection at the time of surgery, the surgery is performed in an ultra-clean air theatre with laminar air flow. Antibiotics are also given before surgery and for 3 to 4 days following the operation. But despite taking all the care and precautions, if the prosthetic components become infected, which is very unusual, additional surgery is usually required to treat the infection.
Sometimes, the infection can be treated without removing the total knee replacement components. In some cases, however, they may need to be removed in order to eradicate the infection. Intravenous antibiotics are generally administered for about 6 weeks to treat the infection. Once the infection is treated, new components can generally be implanted. If there is concern that the infection cannot be eliminated, then a knee fusion (arthrodesis) may be recommended.

The risk of infection persists for as long as the total knee replacement is in place. The most common way that a total knee replacement becomes infected is by spread of bacterial infection from another location in the body. Bacterial infections may be spread from the mouth because of a dental infection; from a urinary tract infection; as a result of pneumonia; from a skin infection; or even an in-grown toenail. It is very important that any bacterial infection be treated promptly in order to minimize the chance of spread to the total knee replacement. It is also recommended that antibiotics be taken before any dental procedure. Similarly, antibiotics should be given if you are going to have any type of invasive procedure such as an endoscopy or bronchoscopy. Viral infections, such as a cold or flu, do not infect total knee replacements.
  • Stiffness:In very few cases, the ability to bend the knee does not return to normal after knee replacement surgery.
  • Loosening: The major reason that artificial joints eventually fail continues to be a process of loosening where the metal or cement meets the bone. Great advances have been made in extending the longevity of an artificial joint, but most will eventually loosen and require a revision. Hopefully, you can expect 12 to 15 years of service from an artificial knee. But in some cases, the knee will loosen earlier than that. A loose prosthesis is a problem because it usually causes pain. Once the pain becomes unbearable, another operation will probably be required to revise the knee replacement.
Dr. Ashutosh P Mavalankar is Consultant Joint Replacement Surgeon, Apollo Hospitals, Ahmedabad.

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