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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; 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@mayo.edu
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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.
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Investigation performed at the Mayo Clinic, Rochester, Minnesota, and the Mayo Clinic Arizona, Phoenix, Arizona

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Nov 01;90(11):2331-2336. doi: 10.2106/JBJS.G.01370
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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.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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