Common Post Lower Limb Arthroplasty Complications, Management Approaches and How to Minimize the Risks

Abstract

Both knee and hip replacements are very successful operations of orthopaedic surgery. They have excellent outcome with long survivorship. Despite the success rate of both joint replacements and with increasing numbers, general complications and some serious complications have also been in-creasing. We reviewed the common complications of lower limb arthroplasty in the literature includ-ing infection, dislocation, periprosthetic fractures, aseptic loosening and venous thromboembolism. Sometimes, those can cause devastating problems and require careful treatments. To minimise these complications, the requirements are skilled and experienced orthopaedic surgeons and teams in specialised units with appropriate environment and proven implants.

Keywords

• arthroplasty,knee,hip,complications

Alt Ekstrimitenin Artroplastileri Sonrası Sık Gözüken Komplikasyonlar, Tedavi Yaklaşımları ve Bunları Nasıl Minimize Ederiz

Öz

Hem diz ve hem de kalça artroplastileri, ortopedinin oldukta başarılı ameliyatlarıdır. Mükemmel ve uzun yaşam sonuçları vardır. Artan ameliyat sayılarına ve başarı oranlarına rağmen, genel ve ciddi komplikasyonları da artış göstermektedir. Literatürden yaptığımız derlemede, kalça ve diz artro-plastilerinin yaygın komplikasyonları olan enfeksiyon, dislokasyon, periprostatik kırıklar, septik gevşeme ve ven tromboembolisini taradık. Bu komplikasyonlar çok dramatik problemlere neden olabilmekte ve dikkatli tedavi gerekmektedir. Bu komplikasyonları minimuma indirgemek icin gerekenler, kendini geliştirmiş tecrübeli ortopedik cerrahlar ve konusunda özelleşmiş, uygun çevresel ortama sahip bir takım ve uygunluğu ispatlanmış protezlerin kullanılmasıdır.

Anahtar Kelimeler

• artroplasti,diz,kalça,komplikasyonlar

Kaynakça

1. 1. Karachalios T, Komnos G, Koutalos A. Total hip arthroplasty: Survival and modes of failure. EFORT Open Rev. 2018;3(5):232-239. doi:10.1302/2058-5241.3.170068
2. 2. Varacallo M, Johanson NA. Total Knee Arthroplasty (TKA) Techniques. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019. Available from: https://www.ncbi.nlm.nih.gov/ books/NBK499896/. Accessed Sep 10, 2019.
3. 3. Crawford R W, Murray D W.Total hip replacement: indications for surgery and risk factors for failure Annals of the Rheumatic Diseases. 1997;56:455-457.
4. 4. Dargel J, Oppermann J, Brüggemann GP, Eysel P. Dislocation following total hip replacement. Dtsch Arztebl Int. 2014;111(51-52):884–890. doi:10.3238/arztebl.2014.0884
5. 5. Sloan M, Premkumar A, Sheth NP. Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am. 2018;100:1455.
6. 6. Chun KC, Kim KM, Chun CH. Infection following total knee arthroplasty. Knee Surg Relat Res. 2013;25(3):93–99. doi:10.5792/ksrr.2013.25.3.93
7. 7. Springer BD, Cahue S, Etkin CD, Lewallen DG, McGrory BJ. Infection burden in total hip and knee arthroplasties: an international registrybased perspective. Arthroplast Today. 2017;3 (2):137-140. doi:10.1016/j.artd.2017.05.003
8. 8. Izakovicova P, Borens O, Trampuz A. Periprosthetic joint infection: current concepts and outlook. EFORT Open Rev. 2019;4(7):482-494. doi:10.1302/2058-5241.4.180092

9. 9. Cury Rde P, Cinagawa EH, Camargo OP, Honda EK, Klautau GB, Salles MJ. Treatment of infection after total total knee arthroplasty. Acta Ortop Bras. 2015;23(5):239-243. doi:10.1590/1413- 785220152305138774
10. 10. Kalore NV, Gioe TJ, Singh JA. Diagnosis and management of infected total knee arthroplasty. Open Orthop J. 2011;5:86-91. doi:10.2174/1874325001105010086
11. 11. Villanueva M, Ríos-Luna A, Pereiro J, FahandezSaddi H, Pérez-Caballer A. Dislocation following total knee arthroplasty: A report of six cases. Indian J Orthop. 2010;44(4):438-443. doi:10.4103/0019-5413.693
12. 12.Zahar A, Rastogi A, Kendoff D. Dislocation after total hip arthroplasty. Curr Rev Musculoskelet Med. 2013;6(4):350-356. doi:10.1007/s12178- 013-9187-6
13. 13.Meek RM, Allan DB, McPhillips G, Kerr L, Howie CR. Epidemiology of dislocation after total hip arthroplasty. Clin Orthop Relat Res. 2006;447:9-18.
14. 14.Bayam L, Drampalos E, Nagai H, Kay P. Conversion of Failed Hip Hemiarthroplasty to Low Friction Arthroplasty (LFA). J Clin Med. 2019;8 (4):503. doi:10.3390/jcm8040503
15. 15.Capone A, Congia S, Civinini R, Marongiu G. Periprosthetic fractures: epidemiology and current treatment. Clin Cases Miner Bone Metab. 2017;14(2):189-196. doi:10.11138/ ccmbm/2017.14.1.189
16. 16. Alden KJ, Duncan WH, Trousdale RT, Pagnano MW, Haidukewych GJ. Intraoperative fracture during primary total knee arthroplasty. Clin Orthop Relat Res. 2010;468(1):90-95. doi:10.1007/ s11999-009-0876-9
17. 17.Lindahl H, Garellick G, Regner H, et al. Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am. 2006;88(6):1215 -1222.
18. 18.Telleria JJ, Gee AO. Classifications in brief: Paprosky classification of acetabular bone loss. Clin Orthop Relat Res. 2013;471(11):3725-3730. doi:10.1007/s11999-013-3264-4
19. 19.Chitre A, Wynn Jones H, Shah N, Clayson A. Complications of total hip arthroplasty: periprosthetic fractures of the acetabulum. Curr Rev Musculoskelet Med. 2013;6(4):357-363. doi:10.1007/ s12178-013-9188-5
20. 20.Whitehouse MR, Mehendale S. Periprosthetic fractures around the knee: current concepts and advances in management. Curr Rev Musculoskelet Med. 2014;7(2):136-144. doi:10.1007/s12178- 014-9216-0
21. 21. Abu-Amer Y, Darwech I, Clohisy JC. Aseptic loosening of total joint replacements: mechanisms underlying osteolysis and potential therapies. Arthritis Res Ther. 2007;9 Suppl 1(Suppl 1):S6. doi:10.1186/ar2170
22. 22. Kutzner I, Hallan G, Høl PJ, et al. Early aseptic loosening of a mobile-bearing total knee replacement. Acta Orthop. 2018;89(1):77-83. doi:10.1080/17453674.2017.139801
23. 23.Iannotti J P, Balderston R A, Booth R E, Rothman R H. Aseptic loosening after total hip arthroplasty. The Journal of Arthroplasty.1986;1(2):99-107.
24. 24. Apostu D, Lucaciu O, Berce C, Lucaciu D, Cosma D. Current methods of preventing aseptic loosening and improving osseointegration of titanium implants in cementless total hip arthroplasty: a review. J Int Med Res. 2018;46(6):2104-2119. doi:10.1177/0300060517732697
25. 25.Lee S, Hwang JI, Kim Y, Yoon PW, Ahn J, Yoo JJ. Venous Thromboembolism Following Hip and Knee Replacement Arthroplasty in Korea: A Nationwide Study Based on Claims Registry. J Korean Med Sci. 2016;31(1):80-88. doi:10.3346/ jkms.2016.31.1.80
26. 26. Flevas DA, Megaloikonomos PD, Dimopoulos L, Mitsiokapa E, Koulouvaris P, Mavrogenis AF. Thromboembolism prophylaxis in orthopaedics: an update. EFORT Open Rev. 2018;3(4):136-148. doi:10.1302/2058-5241.3.170018
27. 27. Almegren MO, Alhedaithy AA, Alomri AS, Albawardy NF, Mesmar RS, Al Qahtani MA. Venous thromboembolism after total knee and hip arthroplasty. A retrospective study. Saudi Med J. 2018;39(11):1096-1101. doi:10.15537/ smj.2018.11.23545
28. 28.Ravi Bheeshma, Jenkinson Richard, Austin Peter C, Croxford Ruth, Wasserstein David, Escott Benjamin et al. Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study BMJ 2014; 348 :g3284
29. 29.Briggs TW. Getting It Right First Time. Stanmore: TWR Briggs; 2012. https:// www.boa.ac.uk/uploads/assets/2b76cbe3-9cf2- 4202-bd32d920eb3e58b2/girft%20executive% 20summary.pdf . Accessed Sep 10, 2019.
30. 30.Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hipreplacement arthroplasties. J Bone Joint Surg Am. 1978;60(2):217-20.
31. 31. Antonios JK, Korber S, Sivasundaram L, Mayfield C, Kang HP, Oakes DA, Heckmann ND. Trends in computer navigation and robotic assistance for total knee arthroplasty in the United States: an analysis of patient and hospital factors. Arthroplast Today. 2019;5(1):88-95. doi: 10.1016/j.artd.2019.01.002
32. 32. Deep K, Shankar S, Mahendra A. Computer assisted navigation in total knee and hip arthroplasty. SICOT J. 2017;3:50. doi: 10.1051/ sicotj/2017034
33. 33.Ren Y, Cao S, Wu J, et al Efficacy and reliability of active robotic-assisted total knee arthroplasty compared with conventional total knee arthroplasty: a systematic review and meta-analysis Postgraduate Medical Journal. 2019;95:125-133.
34. 34. Chang JD, Kim IS, Bhardwaj AM, Badami RN. The Evolution of Computer-Assisted Total Hip Arthroplasty and Relevant Applications. Hip Pelvis. 2017;29(1):1-14. doi:10.5371/ hp.2017.29.1.1
35. 35. Kim YH, Park JW, Kim JS. The Clinical Outcome of Computer-Navigated Compared with Conventional Knee Arthroplasty in the Same Patients: A Prospective, Randomized, DoubleBlind, Long-Term Study. J Bone Joint Surg Am. 2017;99(12):989-996. doi: 10.2106/ JBJS.16.00791