Surgical treatment of early wound complications following primary total knee arthroplasty.

Background: Wound-healing problems are a known complication after primary total knee arthroplasty. However, little is known about the clinical outcomes for patients who require surgical treatment of these early wound-healing problems. The purpose of the present study was to determine the incidence, risk factors, and long-term sequelae of early wound complications requiring surgical treatment.

Methods: The total joint registry at our institution was reviewed for the period from 1981 to 2004. All knees with early wound complications necessitating surgical treatment within thirty days after the index total knee arthroplasty were identified. The cumulative probabilities for the later development of deep infection and major subsequent surgery were determined. A case-control study in which these patients were matched with an equal number of controls was performed to attempt to identify risk factors for the development of early superficial wound complications requiring surgical intervention.

Results: From 1981 to 2004, 17,784 primary total knee arthroplasties were performed at our institution. Fifty-nine knees were identified as having early wound complications necessitating surgical treatment within thirty days after the index arthroplasty, for a rate of return to surgery of 0.33%. For knees with early surgical treatment of wound complications, the two-year cumulative probabilities of major subsequent surgery (component resection, muscle flap coverage, or amputation) and deep infection were 5.3% and 6.0%, respectively. In contrast, for knees without early surgical intervention for the treatment of wound complications, the two-year cumulative probabilities were 0.6% and 0.8%, respectively (p < 0.001 for both comparisons). A history of diabetes mellitus was identified as being significantly associated with the development of early wound complications requiring surgical intervention.

Conclusions: Patients requiring early surgical treatment for wound-healing problems after primary total knee arthroplasty are at significantly increased risk for further complications, including deep infection and/or major subsequent surgery, specifically, resection arthroplasty, amputation, or muscle flap coverage. These results emphasize the importance of obtaining primary wound-healing after total knee arthroplasty.