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Reported Complications Following Total Knee Arthroplasty-Do We Need to Reconsider What, and How, to Measure and Classify Them?

Catherine J Minns, Catherine M Sackley, David W Murray and Karen L Barker

Background: Inadequate data is available regarding the patients’ perspective of complications following total knee arthroplasty. A recent physiotherapy feasibility trial provided opportunity to explore patients’ perspective of complications following total knee arthroplasty, and to reflect upon the extent to which these concur with the Knee Society’s new Standardized List and Definitions of complications.

Purposes: 1. To explore if self report patient data collected post-operatively would provide a different picture of complications than is usually reported using data from medical notes. 2. To develop and describe an approach for a classification system to measure and report post-operative complications that is relevant for physiotherapists, surgeons and patients.

Methods: Prospective survey of patients’ self reported complications and retrospective comparison of patient and medical record accounts of complications was performed during a prospective single blind randomised clinical trial (n=107). Patients were asked to self report complications at 3 and 12 months follow ups. Medical notes of patients reporting major specific complications were examined. Descriptive statistics were used. Self report data was classified into major and minor surgical and non-surgical complications.

Results: 12% (n=11/96) of participants self reported a total of 17 major complications at 3 months and 23% (n=22/96) reported 24 major complications at 12 months. 58% (n=56/96) reported 83 further complications. 38% (n=36/96) participants reported no further complications. Self reported data described greater variety regarding complications than previously seen. Data varied according to source (self report versus medical notes) and differed widely from the Knee Society’s list. A possible classification system is presented and discussed.

Conclusions: Data are presented to stimulate debate regarding how complications should be defined and reported following interventions. Complications following arthroplasty are still being defined and measured by expert opinion. Discussion is needed regarding the collection, interpretation and relevance of complications data to both patients and all healthcare professionals.