Abstract
IntroductionAs the life expectancy and weight of patients are increasing, more old and obese patients are undergoing total knee arthroplasty (TKA). TKA may lead to several perioperative complications. These include anesthesia-related risks, exacerbation of comorbid medical issues and complications of surgical procedure. We have no studies reporting medical complications following TKA among our population. This study aimed to evaluate perioperative complications of TKA and to identify the related risk factors.MethodsIt was a monocentric retrospective including 410 observations in the local TKA registry. Data of patients operated for primary unilateral TKA during the period from January 2014 to December 2017 were reviewed. All patients had standardized protocols of anesthesia and post operative care for three days following surgery. Multivariate logistic regression was used to identify the predicting factors for complications.ResultsIncidence of perioperative complications was 37.1%. The most frequent were per operative hypotension (14.1%) and postoperative desaturation (21.7%, including pulmonary embolism in 2.4%). Multivariate logistic regression analysis identified: age ≥ 65 years (OR=1.9; p=0.006), respiratory diseases (OR=1.8; p=0.042) and general anesthesia (OR=2.8; p=0.009) as significant risk factors for any complications. Loss of autonomy (OR=4.8; p <0.001) and general anesthesia (OR=2.6; p=0.03) were significant risk factors for hypotension. Age ≥ 65 years (OR=2.6;p<0.001), female gender (OR=4.3;p=0.006) and respiratory diseases(OR=1.9;p=0.02) were associated with postoperative desaturation.ConclusionThis study highlighted hemodynamic and respiratory complications as the most common early complications in TKA. Age ≥ 65years, general anesthesia and respiratory diseases were significant risk factors.
Highlights
Total knee arthroplasty (TKA) may be needed to alleviate pain and restore the ability of daily living's activities in advanced stages of Osteoarthritis
We found that significant risk factors were for: any complication: Age>65 years; severe autonomy physical status; metabolic equivalent of task (MET)
Multivariate analysis ascertained that a patient older than 65 years was the most important risk factor for the development of one or more perioperative complications (Table 5)
Summary
Total knee arthroplasty (TKA) may be needed to alleviate pain and restore the ability of daily living's activities in advanced stages of Osteoarthritis. In Tunisia TKA has become a rife procedure because of the ageing of our population and the rising prevalence of overweight especially among women [2]. The prevalence of TKA is not known due to the lack of registries in orthopaedics. As we mentioned its drastic progression, TKA may lead to several perioperative complications. Few well-designed studies, have examined all complications following TKA and with adjustment for potential confounding variables, have focused on risk factors such as age, sex, weight, specific medical co morbidities and surgical parameters and their effect on postoperative mortality, morbidity, and length of hospital stay following TKA. The aim of our study was to elucidate short-term complications occurring intra operatively and during the three days following primary TKA. The second aim was to identify risk factors for such complications
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