Complications of total knee arthroplasty: A 15-year retrospective study of 35 complicated cases

Total knee arthroplasty (TKA) is an effective treatment for disabling gonarthrosis, but complications may compromise function, prolong treatment, and require complex revision strategies. This study aimed to describe the epidemiological profile, spectrum of complications, management, and outcomes of complicated TKA cases treated at our institution. A retrospective single-center study was conducted in the Department of Orthopedic and Traumatology Surgery B4 of Hassan II University Hospital, Fez, Morocco. Across the available records from 2009 to 2024, 278 TKA procedures were identified and 35 patients with one or more perioperative or postoperative complications were included. Data were extracted from medical records, operative reports, imaging, and follow-up visits. Functional assessment relied on the International Knee Society (IKS) score and postoperative pain evaluation. The mean age was 65.8 years (range: 46–80 years), and women accounted for 71.4% of the cohort. Primary gonarthrosis represented 77.1% of indications. Major intraoperative events included one popliteal artery injury and one patellar tendon injury. The most frequent postoperative events were periprosthetic joint infection or septic loosening (12 events), arthrofibrosis (10 cases), aseptic loosening (5 cases), deep venous thrombosis (3 cases), postoperative hematoma (3 cases), and femorotibial dislocation or major instability (3 cases). Mean follow-up was 36 months. Postoperatively, 68.6% of patients reported no pain, the mean IKS score improved from 106 to 156, flexion improved substantially, and radiological normocorrection was achieved in 82.8% of patients. Infectious complications and stiffness were the dominant failure patterns in this series. Early recognition, meticulous technique, multidisciplinary care, and structured follow-up remain essential to improve implant survival and functional recovery.