Clinical Outcomes in Patients Who Require Surgical Evacuation of an Acute Haematoma Following Total Knee Arthroplasty

Since the beginning of the modern era of total knee arthroplasty (TKA) nearly 40 years ago, outstanding independent long-term clinical results have been reported with rates of prosthesis survivorship and patient satisfaction exceeding 90% at 10–15 years.^1–3 Despite these very favourable outcomes, failures do occur; particularly concerning are those that occur within two to three years of the index procedure. The aetiologies of these early failures include surgical errors, such as prosthesis malalignment and inadequate soft tissue balancing, infection, wound complications and haematoma formation.^4,5

While early failures are rare, they may account for approximately 50% of the revisions that occur by 10 years.^4,5 Efforts to further improve long-term success must therefore focus on ways to reduce these early complications. Although host factors can contribute, early failures due to technical errors are largely attributable to surgeon factors. Consequently, improvements in surgeon education and experience can be expected to reduce these complications. Other problems, including those noted above, have multifactorial aetiologies with surgical technique, host factors and other perioperative treatment modalities all potentially contributing.

For complications where numerous factors may be involved and the absolute number of failures due to one specific problem is low, efforts to try to reduce these problems and improve outcomes can be difficult. One such example is post-operative haematoma after TKA. Poor information exists about the development of post-operative wound haematomas.

This is partly due to the wide spectrum of presentation of this problem. Small haematomas may not require any modifications in the standard post-operative protocol and may not cause any significant morbidity. Indeed, some degree of deep haematoma is present in the majority of patients who have undergone TKA.