The Journal of Bone and Joint Surgery (American). 2008;90:2331-2336.
doi:10.2106/JBJS.G.01370
© 2008 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activity for this article:
 CME 4: October, November, December 2008 (publication date January 5, 2009; ...
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Galat, D. D.
Right arrow Articles by Clarke, H. D.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Galat, D. D.
Right arrow Articles by Clarke, H. D.
Related Collections
Right arrow Adult Knee
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Early Return to Surgery for Evacuation of a Postoperative Hematoma After Primary Total Knee Arthroplasty

Daniel D. Galat, MD1, Scott C. McGovern, MD1, Arlen D. Hanssen, MD1, Dirk R. Larson, MS1, Jeffrey R. Harrington, MA1 and Henry D. Clarke, MD2

1 Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
2 Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054. E-mail address: Clarke.henry{at}mayo.edu

Investigation performed at the Mayo Clinic, Rochester, Minnesota, and the Mayo Clinic Arizona, Phoenix, Arizona

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM/DVD (call our subscription department, at 781-449-9780, to order the CD-ROM or DVD).

Background: Development of a postoperative hematoma is a reported complication after primary total knee arthroplasty. However, little is known about the clinical outcomes in patients who require surgical evacuation of an acute hematoma. The purpose of this study was to determine the incidence, risk factors, and long-term sequelae of postoperative hematomas requiring surgical evacuation.

Methods: From 1981 to 2004, 17,784 primary total knee arthroplasties were performed at our institution. Forty-two patients (forty-two knees) returned to the operating room within thirty days of the index arthroplasty for evacuation of a postoperative hematoma. A case-control study, with forty-two patients matched one-to-one with forty-two control subjects, was performed to attempt to identify risk factors for the development of postoperative hematoma requiring surgical evacuation.

Results: The rate of return to surgery within thirty days for evacuation of a postoperative hematoma was 0.24% (95% confidence interval, 0.17% to 0.32%). For patients undergoing postoperative hematoma evacuation, the two-year cumulative probabilities of undergoing subsequent major surgery (component resection, muscle flap coverage, or amputation) or having a deep infection develop were 12.3% (95% confidence interval, 1.6% to 22.4%) and 10.5% (95% confidence interval, 0.2% to 20.2%), respectively. In contrast, for knees without early hematoma evacuation, the two-year cumulative probabilities were 0.6% (95% confidence interval, 0.5% to 0.7%) and 0.8% (95% confidence interval, 0.6% to 0.9%), respectively (p < 0.001 for both outcomes). A history of a bleeding disorder was identified as having a significant association with the development of a hematoma requiring surgical evacuation (p = 0.046).

Conclusions: Patients who return to the operating room within thirty days after the index total knee arthroplasty for evacuation of a postoperative hematoma are at significantly increased risk for the development of deep infection and/or undergoing subsequent major surgery. These results support all efforts to minimize the risk of postoperative hematoma formation.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
C. A. Deirmengian and J. H. Lonner
What's New in Adult Reconstructive Knee Surgery
J. Bone Joint Surg. Am., December 1, 2009; 91(12): 3008 - 3018.
[Full Text] [PDF]