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Operative time, use of biological agents increase risk of complications following TKA

Posted on the ORTHOSuperSite August 12, 2011

Biological agent use and operative time were risk factors in the development of acute surgical site infection and deep vein thrombosis after total knee arthroplasty, according to a study presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.


Kosei Kawakami, MD, shared the results of his team’s 5-year case study.

Orthopedic procedures — including total joint replacement — have improved quality of life,” Kawakami said. “However, complications after surgery, especially postoperative [surgical site infections (SSI)] and [deep vein thrombosis (DVT)] can pose serious functional and psychological challenges.”

Kawakami and his team performed a retrospective study on 392 patients who underwent total knee arthroplasty (TKA) from January 2005 to December 2009. The 1999 Centers for Disease Control and Prevention recommendations were used to define diagnosis of acute SSI in the study, with acute SSI and postoperative DVT risk factors being analyzed through multivariate logistic regression analysis. Factors analyzed included gender, age, BMI, rheumatoid arthritis, presence of diabetes mellitus, cigarette smoking, past history of DVT, revision surgery and operative time.

Kawakami reported that 23 of the 392 patients (5.9%) developed superficial SSI that required antibiotics, with 4 of the 392 patients (1%) developing deep SSI necessitating removal of the prosthesis. Operative time and biological agent use were revealed through regression analysis to be risk factors for acute SSI.

There were also 120 DVT-positive cases (30.6%) in the cohort, with analysis showing operative time, biological agent use, age and presence of diabetes mellitus to be risk factors.

“The use of biological agents was a risk factor for acute SSI and DVT after TKA,” Kawakami said. “Higher age and the presence of diabetes mellitus was a risk factor for DVT after TKA.”


Kawakami K, Ikari K, Iwamoto T, et al. Risk factors for postoperative complications in total knee arthroplasty: 5-year case series. Paper #591. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego.