Complications of Total Knee Arthroplasty: Standardized List and Definitions of The Knee Society

Healy, William L.; Valle, Craig J. Della; Iorio, Richard; Berend, Keith R.; Cushner, Fred D.; Dalury, David F.; Lonner, Jess H.

doi:10.1007/s11999-012-2489-y

Cited by 288 publications

(186 citation statements)

References 21 publications

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“…The data in Table 1 relates to complications identified from the literature before the start of the study. These complications, generally associated with surgery, are often similar to those in the recent Knee Society's list which also began with a literature review [7]. The most frequently raised complications in Table 3 however, pain, falls, long term Non-surgical Minor IIb 3 16 Table 4: Rates of patient self reported complications using the classification system, given in response to specific questions following knee arthroplasty, for 0-3 months (n=92) and 4-12 months (n=93) post operative follow up periods.…”

Section: Discussionmentioning

confidence: 65%

“…The Scottish Arthroplasty Project also collects data for anaesthetic complications such as stroke, acute myocardial infarction and acute renal rates; in addition to complications such as infection, mortality, deep vein thrombosis and pulmonary emboli. Earlier this year the Knee Society published its list and definitions of 22 complications and adverse events following knee arthroplasty to assist the evaluation of surgical results and patient outcomes [7]. This list was developed via a literature review and survey of Knee Society members, relying on expert opinion and not validated as yet by an analysis of patients with knee arthroplasty/ies or with the views of patients themselves.…”

Section: Introductionmentioning

confidence: 99%

“…Problems following lower limb arthroplasty include persistent pain, impairment and functional limitations [9,10]; however we do not know if these are perceived as complications. Pain itself is not present on the Knee Society's recent list of complications which, though concerned with patient outcome, also does not include poor functional ability or dissatisfaction [7]. Explorations of patients' perspectives of outcome following elective orthopaedic surgery show areas of contradiction: participants reporting good outcome may also recount continuing pain and mobility problems [11] and orthopaedic patients may 'optimise' and re-interpret negative experiences and voice them more positively [12] .…”

Section: Introductionmentioning

confidence: 99%

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Reported Complications Following Total Knee Arthroplasty-Do We Need to Reconsider What, and How, to Measure and Classify Them?

Minns¹

2013

J Nov Physiother

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Background: Inadequate data is available regarding the patients’ perspective of complications following total knee arthroplasty. A recent physiotherapy feasibility trial provided opportunity to explore patients’ perspective of complications following total knee arthroplasty, and to reflect upon the extent to which these concur with the Knee Society’s new Standardized List and Definitions of complications. Purposes: 1. To explore if self report patient data collected post-operatively would provide a different picture of complications than is usually reported using data from medical notes. 2. To develop and describe an approach for a classification system to measure and report post-operative complications that is relevant for physiotherapists, surgeons and patients. Methods: Prospective survey of patients’ self reported complications and retrospective comparison of patient and medical record accounts of complications was performed during a prospective single blind randomised clinical trial (n=107). Patients were asked to self report complications at 3 and 12 months follow ups. Medical notes of patients reporting major specific complications were examined. Descriptive statistics were used. Self report data was classified into major and minor surgical and non-surgical complications. Results: 12% (n=11/96) of participants self reported a total of 17 major complications at 3 months and 23% (n=22/96) reported 24 major complications at 12 months. 58% (n=56/96) reported 83 further complications. 38% (n=36/96) participants reported no further complications. Self reported data described greater variety regarding complications than previously seen. Data varied according to source (self report versus medical notes) and differed widely from the Knee Society’s list. A possible classification system is presented and discussed. Conclusions: Data are presented to stimulate debate regarding how complications should be defined and reported following interventions. Complications following arthroplasty are still being defined and measured by expert opinion. Discussion is needed regarding the collection, interpretation and relevance of complications data to both patients and all healthcare professional

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reported Complications Following Total Knee Arthroplasty-Do We Need to Reconsider What, and How, to Measure and Classify Them?

Minns¹

2013

J Nov Physiother

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“…The Knee Society, in an effort to standardize complications reporting in orthopaedic surgery, developed a taskforce that identified and defined what they described as 22 ''minimum necessary TKA complications'' needed for accurate reporting of outcomes after knee replacement [12]. Subsequently, these complications were stratified by severity using a modification of the Clavien-Dindo surgical complication classification system, which has been widely adopted for use in general surgery and surgical subspecialties [3-9, 13-22, 24, 25].…”

Section: Discussionmentioning

confidence: 99%

“…We defined and identified complications according to the method of The Knee Society [12], which, by review of literature and expert consensus, developed a list of complications germane to TKAs which they recommended be included in complication reporting. Complications were graded according to the method of Iorio et al [13] which stratifies complications according to treatment rendered (Table 1).…”

Section: Methodsmentioning

confidence: 99%

Correlations Between a Dedicated Orthopaedic Complications Grading System and Early Adverse Outcomes in Joint Arthroplasty

Harris

McAngus

Kuo

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Reliable classification of postoperative complications is important for quality improvement efforts. In 2014, The Knee Society proposed a grading system for complications after TKA, but to our knowledge, a relationship between complication grades and surgical outcomes has not yet been established. Questions/purposes We attempted to determine (1) whether an association exists between complication grade and early adverse outcomes after TKA and THA, and (2) what proportion of the variability in complications could be associated with the classification grade (a metric of potential predictive value of the grading schema). Methods A total of 210 primary THAs and TKAs in 201 patients performed at one center from January 1, 2011 to December 31, 2011 were reviewed; of those, 188 patients (94%; 197 procedures) had complete 90-day postoperative data and were evaluated retrospectively for postoperative complications. We defined and graded complications according to the classification system proposed by Iorio et al. and The Knee Society. Early adverse outcomes assessed included length of hospital stay and unplanned readmissions or reoperations. A total of 254 complications were documented in 135 patients (137 procedures); 53 patients (60 procedures) had no complications. Bivariate analyses were conducted to identify associations between complication grade and early adverse outcomes and patient variables; analyses considered patient variables including age, sex, status as a state prisoner (yes or no), American Society of Anesthesiologists score, BMI, and procedure (TKA or THA). Multiple regression and logistic regression analyses were conducted to determine the association between complication grade and early adverse outcomes (length of stay [LOS] and unplanned readmission or reoperations) adjusted for confounding patient variables. Alpha was set at 0.05 for two-sided tests. Results Maximum complication grade (range, from 0-4) was associated with a longer LOS (for each point increase of maximum grade, LOS increased 0.105 ± 0.024 days, p \ 0.001) and more readmissions or reoperations (odds ratio [OR], 3.79; 95% CI, 1.91-7.54; p \ 0.001). Total grade (range, 0-22) also was associated with increased LOS (for each point increase of total grade, LOS increased 0.032 ± 0.006 days, p \ 0.001) and increased readmissions or reoperations (OR, 1.34; 95% CI, 1.18-1.53; p \ 0.001). Total grade could account for 38% of the variation in LOS and readmissions or reoperations (C-statistic = 0.94; 95% CI, 0.90-0.98); whereas maximum complication grade could account for 35% of the variation in LOS and readmissions or reoperations (C-statistic = 0.35; 95% CI, 0.88-0.96). Thus, we found total grade to be a slightly better predictor of LOS and readmissions or reoperations than maximum grade. Conclusions We found that the proposed grading system is applicable to TKA and THA in terms of documentation Each author certifies that he/she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensi...

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Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2)

et al. 2020

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IMPORTANCE The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery.OBJECTIVE To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). DESIGN, SETTING, AND PARTICIPANTS This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019. EXPOSURES Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not. MAIN OUTCOMES AND MEASURES The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality. RESULTS During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%];OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P < .001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P < .001) and moderate to severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84; P < .001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR,[4][5][6] days; OR, 0.97; 95% CI, 0.96-0.99; P < .001). CONCLUSIONS AND RELEVANCEAn increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes.

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Complications of Total Knee Arthroplasty: Standardized List and Definitions of The Knee Society

Abstract: Background Despite the importance of complications in evaluating patient outcomes after TKA, definitions of TKA complications are not standardized. Different investigators report different complications with different definitions when reporting outcomes of TKA.

Cited by 288 publications

References 21 publications

Reported Complications Following Total Knee Arthroplasty-Do We Need to Reconsider What, and How, to Measure and Classify Them?

Reported Complications Following Total Knee Arthroplasty-Do We Need to Reconsider What, and How, to Measure and Classify Them?

Correlations Between a Dedicated Orthopaedic Complications Grading System and Early Adverse Outcomes in Joint Arthroplasty

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2)

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