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As a family, the three adult children of our family are searching out information about knee replacements. Both our parents need at least one. Dad may need both knees replaced. My job is to find out more about the "what-can-go-wrong" side of things. What should we be prepared to face if something should go south?

There is always the risk of complications and problems with any surgery. Fortunately, the number of patients affected is low at most hospitals or centers for joint surgery. But they can occur and being prepared ahead of time helps mobilize the family into action when necessary. The most serious complication is death from blood clots, heart attacks, or strokes. Poor wound healing, deep infection, and implant failure head the list of other more common problems. Who is at risk? According to a recent review study, it looks like patients who have other health issues have an overall higher rate of complications and increased risk of poor outcomes with their knee implant. Dislocations, deep infections, and implant loosening and failure were observed in the group at-risk due to poor health. Implant failure requiring reoperation is most commonly linked with infection. Risk factors include male sex, patients with rheumatoid arthritis, and history of bone fracture anywhere around the knee. Infection is less likely when implants are put in place with cement that has antibiotic in it or when the patient is receiving intravenous (IV) antibiotics directly to the bloodstream. Additional factors that increase the risk of infection include obesity (body mass index greater than 50), diabetes, and younger age. Diabetes was actually a major complicating factor. Patients with diabetes were more likely to suffer serious complications of surgery such as stroke, delayed wound healing, and amputation because of deep, uncontrolled infection. Consider going with your parents to their appointments and asking the surgeon what risk factor your parents have, the likelihood of problems developing, and what you can do to help. Preparation and prevention are two important keys to reducing complications. You are well on your way to making a difference for your parents just by asking the right questions!

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