Total Knee Arthroplasty Wound Complication Treatment Algorithm: Current Soft Tissue Coverage Options

Nirav H Amin; Joshua N Speirs; Matthew J Simmons; Oren Z Lermen; Fred D Cushner; Giles R Scuderi

doi:10.1016/j.arth.2018.12.016

Total Knee Arthroplasty Wound Complication Treatment Algorithm: Current Soft Tissue Coverage Options

J Arthroplasty. 2019 Apr;34(4):735-742. doi: 10.1016/j.arth.2018.12.016. Epub 2018 Dec 20.

Authors

Nirav H Amin¹, Joshua N Speirs¹, Matthew J Simmons², Oren Z Lermen³, Fred D Cushner⁴, Giles R Scuderi⁴

Affiliations

¹ Department of Orthopedic Surgery, Loma Linda University, Loma Linda, CA.
² Department of Orthopedic Surgery, Sierra Pacific Orthopedic Center, Fresno, CA.
³ Department of Plastic Surgery, Lenox Hill Hospital, New York, NY.
⁴ Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY.

PMID: 30665832
DOI: 10.1016/j.arth.2018.12.016

Abstract

Background: Wound complications associated with soft tissue defects following total knee arthroplasty present challenges for the orthopedic surgeon. The scale of early complications include less morbid problems, such as quickly resolving drainage and small superficial eschars, to persistent drainage and full-thickness tissue necrosis, which may require advanced soft tissue coverage.

Methods: This review outlines current wound management strategies and provides an algorithm to help guide treatment and clinical decision-making.

Conclusion: A surgeon's understanding of soft tissue coverage options is essential in protecting the knee prosthesis from a deep infection and to obtain an optimal functional outcome.

Keywords: arthroplasty; draining wound; exposed hardware; flaps; total knee arthroplasty; wound complication.

Publication types

Review

MeSH terms

Algorithms
Arthroplasty, Replacement, Knee / adverse effects*
Debridement
Drainage
Humans
Necrosis
Negative-Pressure Wound Therapy
Postoperative Complications / therapy*
Skin Transplantation*
Surgical Flaps*
Wound Healing