Knee replacement does not always go smoothly and may have a number of complications.
Page updated December 2023 by Dr Sheila Strover (Clinical Editor)
Immediately after knee replacement surgery, the joint may suddenly swell up because of bleeding into the joint space. This is a particular problem because the surgeon will be reluctant to put a needle into the joint to aspirate the blood, in case of the introduction of infection.
Deep vein thrombosis (DVT)
Deep vein thrombosis is important, not only because it may make the lower limb swollen and painful from clots in the veins, but because there is always the danger of a clot breaking off and shooting to the lungs, causing breathing distress and possibly even death.
Superficial and deep infection
Even a superficial wound infection will be managed seriously after knee replacement, with swabs sent to the laboratory for identification of the offending organism's and experts called in from the laboratory to advise on the best regime of treatment. All efforts are made to keep the infection from tracking deeper into the knee cavity, where septic arthritis can cause the patient to feel very unwell, and tissue destruction can put the prosthesis at risk of needing to be removed.
Mechanical failure of a knee prosthesis is indicated by absence of pain relief. In addition there may be new stiffness or instability, or new pain over the kneecap. Failure may be due to an incorrectly-sized prosthesis, excessive tension on or even breakage of the posterior cruciate ligament and subsidence of the prosthesis with excessive laxity.
Arthrofibrosis is a nasty complication in the early days after surgery is stiffness due to adhesions in the soft tissues around the joint. If they are not promptly dealt with, then arthrofibrosis scarring may follow. Early physiotherapy massages and stretches may be followed by manipulation under anaesthesis (MUA) to try and break down any adhesions before they mature into scar tissue.
- "Re: 2nd Knee Revision Tomorrow"
Long history of stiffness after knee replacement.
"The literature reports high mortality rates during the first 30 postoperative days, as well as high complication and morbidity rates in patients with advanced age....Thus, the adequate clinical follow-up is one year."
Citation: Souza GGA, Ramalho RSC, Albuquerque RSPE, Barretto JM, Chaves RSM, de Sousa EB. HIGHER RISK OF COMPLICATIONS AFTER TOTAL KNEE ARTHROPLASTY IN OCTOGENARIANS. Acta Ortop Bras. 2020 Jul-Aug;28(4):177-181. doi: 10.1590/1413-785220202804230946. PMID: 32788859; PMCID: PMC7405842.
Complications of arthroplasty -
- Deep vein thrombosis (DVT)
- Loosening of bone cement
- Septic arthritis
Arthroplasty failure -
From the Experts -
- Journal interpretation - 2009 - The management of patients with painful total knee replacement - Authors: Toms AD et al and interpreted for you by Dr Sheila Strover (Clinical Editor)