Knee Replacement Complications & Risks

Total knee replacement is one of the most common surgeries performed by orthopedic surgeons. Complications arising after a knee replacement surgery are rare but are discussed in detail with the patient before they undergo the surgery. With the advancement of implant technology and surgical techniques, knee replacements today may last for 25 years or more and in some cases, a lifetime.

Anaesthesia Complications
Knee replacement surgeries are commonly performed under general anesthesia or under spinal anesthesia. During general anesthesia, the patient sleeps during the surgery while they feel no pain/sensation. In spinal anesthesia, only the pelvis and the legs are numb while the patient is sedated.

The attending anesthesiologist carefully assesses the patient before they are under anesthesia. Their medical and medication history are carefully evaluated. However, following general anesthesia, some patients may complain of breathing difficulty, shivering, vomiting, sore throat, pain, and drowsiness, etc.

Similarly, after spinal anesthesia, patients may complain of pain at the surgical site. Some patients may complain of breathing difficulty in case the level of anesthesia is high up. Additionally, there may be post-anesthesia inability to void urine, and in rare cases, there may be a collection of blood (hematoma) around the spinal level. Epidural hematoma is a surgical emergency and if not drained quickly, may lead to paralysis.

Injury to blood vessel

The incidence of vascular injury during a total knee replacement is rare but may have drastic consequences. During the surgery, there is a risk of inadvertent cutting of the major blood vessel of the leg. Blood vessel injury may also result from excessive pressure placed on the artery.

The injury to the major blood vessel (popliteal artery) may present brisk bleeding and loss of pulse in the leg during the surgery. The bleeding may be controlled by repair of the involved vessel. In some cases, the injury may present after the surgery with loss of sensation in the leg along with weak or absent pulses in the leg. In rare advanced cases, there may be skin color change along with gangrene.

Intraoperative image showing total knee replacement.

Intraoperative image showing total knee replacement.

Nerve Injury

A nerve known as the peroneal nerve is responsible for upward movement of the foot and sensation from the side of the lower leg. The nerve lies close to the side of the knee during surgery. Excess pressure during retraction or direct cut on the nerve may lead to injury. The peroneal nerve injuries commonly present with the inability to lift the foot up and subsequent foot drop.

Pressure injuries may get better over a few months, however, serious injuries and cuts over the nerve may not recover. The nerve injuries are more common in patients with severe knock knees who need replacement surgery. A foot and ankle orthosis may be used in the management of foot drop after knee replacement.

Blood lots

Knee replacement surgery like other major surgeries is a risk factor for the formation of blood clots. The blood clots may form in the veins of the legs and may travel up to the lungs. A blood clot in the lungs known as pulmonary embolism may be fatal unless promptly treated.

The risk of blood clots is decreased by starting the patient on blood thinners such as aspirin or heparin after the surgery. The blood thinner medications prevent the formation of blood clots. Similarly, patients are advised to move their legs and walk after the surgery as total bed rest is a known risk for blood clots.

Wound Complications

The risk of wound complications is high in patients with a prior history of diabetes mellitus, prior surgery of the knee, smoking, obesity, blood vessel disease, etc. the wound complications may present as a non-healing wound, skin discoloration (blackening), discharged from the surface, pain, warmth, etc.

Wound complications may be addressed by the use of antibiotics and removal of dead skin. The remaining wound may be re-sutured or skin may be used from another site to fill in space. Plastic surgery may often help to close the wound in complicated cases.

Fracture

There may be an increased risk of fracture of the thigh bone or the shin bone in patients with poor bone quality (elderly, steroid use, or metabolic bone disease). The fracture of the bone may occur during the surgery or after the surgery. The periprosthetic fracture usually requires surgical management. Rarely, non-displaced fractures may be treated non-surgically in the form of casting or bracing.

Loosening

Aseptic loosening of the implant occurs in the absence of any infection. Various factors including patient activity, choice of implant, and stability play a role in aseptic loosening. The plastic spacer may wear and generate very small particles.

The particles rub in between the implant surfaces and even more particles may be generated. The body’s immune system recognizes the particles as foreign bodies and tries to fight them with inflammation. The resulting inflammation may erode the bone surrounding the implant leading to loosening.

Instability

The patients with instability after knee replacement may complain of laxity and pain which usually gets worse with movement. The management is usually surgical and may require a different-sized prosthesis.

Patellar maltracking

The kneecap may not glide in the groove formed by the lower end of the thigh bone and the femoral component of the prosthesis. The maltracking may be caused by instability, malpositioning, or the design of the implant. The patients may complain of kneecap shifting out of place on bending or straightening the knee.

Patellar clunk syndrome

A tough fibrous tissue may form underneath the quadriceps tendon just at the junction of the patella. The tissue gets caught with the femoral component of the prosthesis during bending and straightening of the leg. The patients may complain of catching or popping of the knee on bending/straightening. The nodule may be removed with the help of an arthroscope.

Others

One of the most common complications after a total knee replacement is stiffness of the operated knee. The stiffness usually results from non-compliance with physical therapy and exercise. Other complications include abnormal bone formation in the muscles known as heterotrophic ossification, rupture of the extensor mechanism, or rarely metal hypersensitivity.

Conclusion

The complications of total knee replacement occur in an extremely small proportion of patients. The knee replacement surgery is one of the most successful surgeries in orthopedics with excellent results in a vast number of patients. The possible complications are discussed with all the patients before the surgery.

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No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
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19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
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03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
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14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.