The Analysis And Research Of Risk Factors For Incision Complications After Primary Total Knee Arthroplasty

Objective:To research and analyze the incision complications after primary knee arthroplasty and the associated risk factors. The animal experiments and randomized controlled experimental studies were conducted to evaluate the effect of suture by using different types of suture material. To study on the influence of rheumatoid arthritis and malnutrition status on postoperative wound healing.Methods:Review 405 cases that had been undertaken primary knee arthroplasty within 6 months. All patients'short-term outcomes after operation were obtained through follow-up visits. Statistical analysis was made on the case records and preoperative conditions investigated to find the risk factors associated with incision complications. Studies on the effect of bi-directional barbed sutures compared with absorbable sutures were performed. The Beagle is selected as experimental animal model to observe the pathological changes and the skin healing.68 patients who had been undertaken primary bilateral knee arthroplasty were recruited in the matching study to observe the postoperative wound healing.104 patients with unilateral TKAare selected to find out thedifference inpostoperative incision complication between rheumatoid arthritis and osteoarthritis. A total of 116 patients who underwent primary total knee arthroplasty for osteoarthritis are selected to explore the impact of malnutrition on wound healing.Results:History of rheumatoid disease, history of hormone application, smoking, bi-directional barbed sutures, postoperative anemia and lower postoperative serum albumin were associated with incision complications after knee arthroplasty. History of rheumatoid disease(P=0.001), bi-directional barbed sutures(P=0.003), postoperative anemia(P<0.001) and lower postoperative serum albumin(P=0.016) were independent risk factors. During the process of skin wound healing of beagle, differences were existed between degree of inflammatory reaction of different types of sutures. However, all groups had good wound healing. Compared with absorbable sutures, incidence of complications including exudation(6.25%), facial infection(6.25%) and blister(3.13%) were slightly higher during the usage of bi-directional barbed sutures clinically. However, there were no statistically significant differences.Compared with control group, the incidence of incision complications in RAgroup(31.58%) and malnutritiongroup(29.09%)weresignificantly higher (P<0.05).Conclusion:History of rheumatoid disease, bi-directional barbed sutures, postoperative anemia and lower postoperative serum albumin are independent risk factors in all incision complications after primary knee arthroplasty. Attention should be given to the patients with risk factors to prevent them from complications. Bi-directional barbed sutures are more convenient than the absorbable sutures. Although they can shorten the operation time significantly, we should strictly comply with the requirements of the use of the sutures because they have a slightly higher incidence of complications of incision.We should pay more attention to patients with RA or malnutrition, because of higherincidence of incision complications.