Abstract
Total knee arthroplasty is a reliable and durable solution to knee arthritis that fails conservative management. However, there are clinical pitfalls awaiting the surgeon, which can be avoided with forethought and analysis. The majority of early TKR failures are related to technical error on the part of the surgeon! The top 10 errors are:
- 10.
The knee attached to secondary gain: worker's comp, depression, etc. will make a successful outcome less likely.
- 9.
Wound complications: raising large subcutaneous flaps, failure to respect pre-existing incisions about the knee, and delay in obtaining closure with flaps, etc. will almost guarantee infection!
- 8.
Prolonged observation of the draining wound: another invitation to infection!
- 7.
Internal rotation of the femoral component: patellar maltracking, and flexion instability await!
- 6.
Infection: discipline for the OR staff and surgeon alike are necessary to minimise this complication.
- 5.
Varus position of the tibial component: early loosening and accelerated polyethylene wear are assured.
- 4.
Failure to restore a neutral mechanical axis of the limb: early wear and loosening are the outcome of failure to pay attention to this very important basic principle of TKR.
- 3.
Patellar tilt or dislocation: lateral retinacular release is less common with current designs, but is still required for proper patellar tracking.
- 2.
Failure to balance soft tissue: collateral ligament, and the posterior cruciate ligament must be balanced throughout the range of motion for a successful result.
And the #1 way to ruin a good result is…
Operating too early! Don't operate on the x-ray, and exhaust all reasonable conservative therapy and non-arthroplasty alternatives before resorting to prosthetic arthroplasty. The patient needs to understand the limitations of technology, and have reasonable expectations. Make sure the pre-op symptoms justify the procedure!
