TITLE

Early Return to Surgery for Evacuation of a Postoperative Hematoma After Primary Total Knee Arthroplasty

AUTHOR(S)
Galat, Daniel D.; McGovern, Scott C.; Hanssen, Arlen D.; Larson, Dirk R.; Harrington, Jeffrey R.; Clarke, Henry D.
PUB. DATE
November 2008
SOURCE
Journal of Bone & Joint Surgery, American Volume;Nov2008, Vol. 90-A Issue 11, p2331
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Development of a postoperative hematoma is a reported complication after primary total knee arthroplasty. However, little is known about the clinical outcomes in patients who require surgical evacuation of an acute hematoma. The purpose of this study was to determine the incidence, risk factors, and long-term sequelae of postoperative hematomas requiring surgical evacuation. Methods: From 1981 to 2004, 17,784 primary total knee arthroplasties were performed at our institution. Forty-two patients (forty-two knees) returned to the operating room within thirty days of the index arthroplasty for evacuation of a postoperative hematoma. A case-control study, with forty-two patients matched one-to-one with forty-two control subjects, was performed to attempt to identify risk factors for the development of postoperative hematoma requiring surgical evacuation. Results: The rate of return to surgery within thirty days for evacuation of a postoperative hematoma was 0.24% (95% confidence interval, 0.17% to 0.32%). For patients undergoing postoperative hematoma evacuation, the two-year cumulative probabilities of undergoing subsequent major surgery (component resection, muscle flap coverage, or amputation) or having a deep infection develop were 12.3% (95% confidence interval, 1.6% to 22.4%) and 10.5% (95% confidence interval, 0.2% to 20.2%), respectively. In contrast, for knees without early hematoma evacuation, the two-year cumulative probabilities were 0.6% (95% confidence interval, 0.5% to 0.7%) and 0.8% (95% confidence interval, 0.6% to 0.9%), respectively (p < 0.001 for both outcomes). A history of a bleeding disorder was identified as having a significant association with the development of a hematoma requiring surgical evacuation (p = 0.046). Conclusions: Patients who return to the operating room within thirty days after the index total knee arthroplasty for evacuation of a postoperative hematoma are at significantly increased risk for the development of deep infection and/or undergoing subsequent major surgery. These results support all efforts to minimize the risk of postoperative hematoma formation. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
ACCESSION #
35282007

 

Related Articles

  • Knee Arthroscopy in England and Ontario: Patterns of Use, Changes Over Time, and Relationship to Total Knee Replacement. Hawker, Gihian; Guan, Jun; Judge, Andy; Dieppe, Paul // Journal of Bone & Joint Surgery, American Volume;Nov2008, Vol. 90-A Issue 11, p2337 

    Background: The role of knee arthroscopy in the management of osteoarthritis is unclear. The purpose of this study was to examine patterns of use of knee arthroscopy, overall and by diagnostic and sociodemographic subgroups, in countries with comparable health-care systems. Methods:...

  • Unicondylar Arthroplasty: Redefining Itself. Scott, Richard D. // Orthopedics;Sep2003, Vol. 26 Issue 9, p951 

    The article discusses unicondylar knee arthroplasty (UKA) as a treatment option for selected patients with unicompartmental osteoarthritis. The treatment has been in use since 1970 but its use has been controversial for the past three decades. It states that unicondylar knee arthroplasty is in...

  • Patient-specific uni-knee implants and instruments may simplify procedures. Press, Robert // Orthopedics Today;Nov2009, Vol. 29 Issue 11, p9 

    This article discusses research being done on patient-specific unicompartmental knee arthroplasty (UKA) as a treatment for osteoarthritis.

  • Surgical Options for the Middle-Aged Patient with Osteoarthritis of the Knee Joint. Hanssen, Arlen D.; Stuart, Michael J.; Scott, Richard D.; Scuderi, Giles R. // Journal of Bone & Joint Surgery, American Volume;Dec2000, Vol. 82-A Issue 12, p1768 

    Discusses surgical options for treating osteoarthritis of knee joint in middle-aged patient. Arthroscopy and ligament reconstruction; Variables used for selection of the surgical procedure; Realignment osteotomy; Unicompartmental knee arthroplasty; Total knee arthroplasty.

  • The relative safety of one-stage bilateral total knee arthroplasty. J. Luscombe; A. Abudu; S. Carter // International Orthopaedics;Feb2009, Vol. 33 Issue 1, p101 

    Abstract��Patients with osteoarthritis of the knee often require bilateral knee replacement before fulfilling their full ambulatory potential. Despite extensive research there is considerable debate about the risks of performing simultaneous bilateral knee replacements under the same...

  • Second Look.  // AAOS Now;Jun2013, Vol. 7 Issue 6, p9 

    The article offers news briefs on orthopaedic surgery as of June 2013. The study presented in the May 2013 issue of "Journal of Shoulder & Elbow Surgery" shows little efficacy on treating glenohumeral osteoarthritis (GH-OA) with sodium hyaluronate (HA). The study presented in the May 2013 issue...

  • Lateral Soft Tissue Laxity Increases but Medial Laxity Does Not Contract With Varus Deformity in Total Knee Arthroplasty. Okamoto, Shigetoshi; Okazaki, Ken; Mitsuyasu, Hiroaki; Matsuda, Shuichi; Iwamoto, Yukihide // Clinical Orthopaedics & Related Research;Apr2013, Vol. 471 Issue 4, p1334 

    Background: In TKA, soft tissue balance (the joint gap) depends on the amount of resected bone and soft tissue release. Some studies report preoperative bony deformity correlates with soft tissue balance evaluated intraoperatively and that the medial tissues are contracted with varus deformity....

  • Is the Medial Wall of the Intercondylar Notch Useful for Tibial Rotational Reference in Unicompartmental Knee Arthroplasty? Kawahara, Shinya; Matsuda, Shuichi; Okazaki, Ken; Tashiro, Yasutaka; Iwamoto, Yukihide // Clinical Orthopaedics & Related Research;Apr2012, Vol. 470 Issue 4, p1177 

    Background: It is difficult to implant components in the correct rotational position in the narrow operating field in a unicompartmental knee arthroplasty. Although no rotational reference has been confirmed for unicompartmental knee arthroplasty, the AP axis of the tibia may serve as a...

  • What's New in Adult Reconstructive Knee Surgery. Archibeck, Michael J.; White Jr., Richard E. // Journal of Bone & Joint Surgery, American Volume;Jul2003, Vol. 85-A Issue 7, p1404 

    Treatment of Osteoarthritis without Arthroplasty. While total knee replacement has been very successful for alleviating pain and improving function in patients of all ages, other approaches remain the initial treatment option for many patients with knee arthritis. Unicompartmental knee...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics