Complications of Total Hip and Total Knee Arthroplasty: Lessons Learned

Over the past four decades, an evolution of peri-operative medical management, surgical technique, implant designs, and rehabilitation protocols have led to improved results with fewer complications. Currently, in the U.S. 200,000 total hip replacements (18% revisions) and 300,000 total knee replacements (8.0% revisions) are performed on a yearly basis. Outcome studies for these total joint replacements looking at health-related quality of life issues have shown a marked increase in overall physical function with a decrease in pain [9, 10, 14, 17, 18, 20, 34, 40], Total knee arthroplasty (TKA) improves at a slower rate than total hip arthroplasty (THA), but the quality of life outcomes are greatly improved for both. The predictors in general for inferior results include the presence of co-morbidities of a systemic nature, previous hip and/or knee surgery, young age, and low severity of disease pre-operatively [6, 12, 15, 22]. Patients who are most disabled pre-operatively tend to have the best results post-operatively. Additionally, key contributors to the ultimate outcome of THA and TKA include patient expectations, surgeon expertise and experience [1, 2, 23, 25, 27].