Peri-Incisional Blisters after Total Knee Arthroplasty: Risk Factors and Clinical Implications

Peri-incisional blistering following total knee arthroplasty (TKA) is a recognized, but underreported, complication that negatively impacts postoperative recovery and overall patient satisfaction. This retrospective study examined the incidence of postoperative blistering, associated patient and surgical risk factors, and its relationship with adverse outcomes, including reoperation and periprosthetic joint infection.

We retrospectively identified 23,405 elective unilateral primary TKAs performed in 20,035 patients at a single high-volume center between March 2016 and May 2022. The TKAs meeting inclusion criteria were identified through an electronic medical record keyword search for "blister" documented within 30 days of surgery and confirmed by manual chart review. Multivariable logistic regression models adjusting for patient age, sex, race, body mass index (BMI), Charlson Comorbidity Index, and year of surgery were used to examine the association of these factors with blister formation and adverse outcomes.

The incidence of 30-day peri-incisional blistering was 3.1% (714 of 23,405 TKAs). In adjusted analyses, preoperative anticoagulation and BMI ≥ 40.0 were associated with increased odds of postoperative blister formation (odds ratio [OR] 1.25; 95% confidence interval [CI], 1.07 to 1.47 and OR 1.59; 95% CI, 1.25 to 2.02, respectively). Blister formation was the strongest associated factor for both reoperation and infection (OR 2.13; 95% CI, 1.50 to 3.02 and OR 4.24; 95% CI, 2.52 to 7.16, respectively), exceeding current smoking status, the next strongest associated factor for infection (OR 2.05; 95% CI, 1.09 to 3.82). The use of advanced surgical dressings had lower odds of blister formation (OR 0.57; 95% CI, 0.46 to 0.69). All associations had P-values < 0.05.

Postoperative blister formation following TKA was associated with increased risk of reoperation and infection. Postoperative blistering may serve as a clinical marker identifying patients who are at elevated risk and who warrant heightened monitoring and wound management.