Thirty-day mortality and morbidity after total knee arthroplasty.

INTRODUCTION: Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures to date. It is estimated that over 130,000 of TKAs are performed in the United States every year. Whilst the procedure is safe, it nevertheless carries a risk of perioperative mortality and morbidity. This study aimed to report the mortality rate within 30 days after a TKA, as well as to assess the incidence of early postoperative morbidities. MATERIALS AND METHODS: We reviewed a total of 2219 TKAs performed by multiple surgeons in our centre from 1998 to 2001. All mortalities within 30 days of a TKA were recorded. Morbidities such as infection, thromboembolic phenomenon, and any re-admissions within 30 days of operation or 15 days of discharge were recorded. RESULTS: The mortality rate within 30 days of a TKA was 0.27% (6 of 2219 patients). The incidence of early postoperative infection was 1.8%, of which 1.44% were superficial and 0.36% were deep infections. There were 3 cases (0.13%) of pulmonary embolism and 22 cases (0.99%) of deep vein thrombosis. CONCLUSIONS: The 30-day mortality rate, and the incidence of infection after TKA performed in our institution is comparable to other centres around the world, and further emphasises that TKA is a safe procedure. However, the small number of mortalities in this study does not allow us to identify a predominant cause of perioperative mortality.

Isolated patellar revisions for failed metal-backed components: 2- to 9-year follow-up.

Results of isolated patellar revisions for failed metal-backed patellae remain controversial. Isolated patellar revisions from April 1993 to April 2000 were assessed for complication rates, the Knee Society score (KSS), implant survival, and radiological loosening. Twenty-nine knees were revised in patients aged 71.0 years (range, 61-87; SD, 6.2). At 67.0 months (range, 24-98 months; SD, 22.0), no patient underwent further revision. Knee scores improved by 26.5 (range, 9.0-44.0; SD, 10.9) while function scores improved by 25.0 (range, 0-50.0; SD,14.5) over prerevision values. Early complications included 3 superficial wound infections, 1 hematoma, and a urinary tract infection in 1 patient. One patient had a subluxed patella. One patient had asymptomatic femoral osteolysis on radiological evaluation. Isolated patellar revisions can be performed in low-demand, elderly patients with minimal patellar maltracking.