Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Common Complications of Total Knee Arthroplasty*†

The success of a total joint arthroplasty is contingent on a clear understanding of the potential complications of the procedure. This Instructional Course Lecture presents a review of specific problems related to wound-healing, neurovascular injuries, infections, thromboembolic disease, the extensor mechanism, stiffness, and periprosthetic fractures to provide the reader with a clear understanding of ways to avoid and treat these common complications. Primary wound-healing is critical for the success of any total knee arthroplasty. Any delay in wound-healing increases the risk of infection and failure of the arthroplasty214,216. The prevention of soft-tissue problems through the selection of the proper skin incision, an understanding of the vascular anatomy and patient-related risk factors, and prompt treatment of wound problems (should they arise) are imperative if a good result is to be achieved. ### Vascular Anatomy The blood supply to the soft tissues of the anterior aspect of the knee is completely random, with contributions from multiple vessels2,23,43,161,203,258,295. This blood supply arises predominantly from the terminal branches of the peripatellar anastomotic arterial ring, which has numerous contributing arterial branches, including the medial and lateral superior genicular arteries, the medial and lateral inferior genicular arteries, the supreme genicular artery, the anterior tibial recurrent artery, and a branch of the profunda femoris artery. In contrast to the skin circulation of the thigh proximal to the knee, there is no underlying muscle or intermuscular septum directly anterior to the knee to provide a direct pathway for arterial perforators43,161. Skin circulation in this area is dependent on the dermal plexus, which originates directly from arterioles traveling within the subcutaneous fascia. Any operative dissection performed superficial to this subcutaneous fascia disrupts the arterial supply to the skin and increases …