TKA Complications

Question 1

What is the most common reason for secondary surgery after TKA?

Answer 1

Patellar maltracking.

Question 2

What are some iatrogenic causes of coronal instability in TKA?

Answer 2

1) Transection by oscillating saw during posterior cuts
2) Tibial avulsion
3) Incorrect bone cuts
4) Inadequate correction of deformity

Question 3

What are some iatrogenic causes of flexion/extension instability?

Answer 3

1) Over-resection of posterior condyles (augments)
2) Undersizing femur (upsize)
3) Excessive tibial slope (reduce slope or use PCL substituting)
4) Excessive distal femur cut (augments)

Question 4

What is a relative indication for MUA in TKA?

Answer 4

Flexion <90 at 6-12 weeks post-op.

Question 5

What are options for an extensor mechanism rupture in TKA?

Answer 5

1) Primary repair (<30% avulsion)
2) Primary repair with graft augmentation (adequate patellar bone stock)
3) Allograft (inadequate bone stock or soft tissue, chronic rupture)

Question 6

What are risk factors for peroneal nerve palsy in TKA?

Answer 6

1) Valgus and/or flexion deformity
2) Tourniquet time >120min
3) Retractors

Question 7

What is the prognosis for peroneal nerve recovery in TKA?

Answer 7

50% improve without treatment.

Question 8

What are risk factors for HO in TKA?

Answer 8

1) Periosteal stripping
2) male gender
3) Obesity
4) Post-traumatic deformity
5) Pre-operative osteophytes

Question 9

If a patient fails conservative management with AFO and neurolysis for peroneal palsy following TKA, what surgical option is indicated?

Answer 9

Bridle procedure (posterior tibial tendon transfer through IO membrane to lateral cuneiform, peroneus longus to front of lateral mal)

Question 10

Do males of females have better outcomes with standard TKA components?

Answer 10

Females.

Question 11

What are risk factors for post-operative periprosthetic femur fractures in TKA?

Answer 11

1) female gender
2) Parkinson’s
3) Rheumatoid
4) Chronic steroid
5) Osteopenia/osteoporosis