Berliner diagnostischer Algorithmus der schmerzhaften Knie-TEP

Thiele, Kathi; Fussi, Jasmin; Perka, Carsten; Pfitzner, Tilman

doi:10.1007/s00132-015-3196-7

Cited by 20 publications

(4 citation statements)

References 62 publications

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“…The authors acknowledge that diagnostic algorithms of the painful TKA are discussed controversial and are still under investigation [ 8 – 12 ]. Thus, the predominant indications for revision are described in brief: PE-wear was diagnosed by radiographs showing osteolysis or progressive joint space narrowing under load, by intraoperatively macroscopic visible wear and by histopathologic evaluation of intraoperative samples according to Krenn and Morawietz [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Periprosthetic infection is the major indication for TKA revision – experiences from a university referral arthroplasty center

Boelch

Jakuscheit

Doerries

et al. 2018

BMC Musculoskelet Disord

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BackgroundWe hypothesized, that periprosthetic joint infection (PJI) accounts for the major proportion of first (primary) and repeated (secondary) Total Knee Arthroplasty revisions at our university referral arthroplasty center.MethodsOne thousand one hundred forty-three revisions, performed between 2008 and 2016 were grouped into primary (55%) and secondary (45%) revisions. The rate of revision indications was calculated and indications were categorized by time after index operation. The odds ratios of the indications for primary versus secondary revision were calculated.ResultsIn the primary revision group PJI accounted for 22.3%, instability for 20.0%, aseptic loosening for 14.9% and retropatellar arthrosis for 14.2%. PJI (25.6%) was the most common indication up to 1 year after implantation, retropatellar arthrosis (26.8%) 1–3 years and aseptic loosening (25.6%) more than 3 years after implantation.In the secondary revision group PJI accounted for 39.7%, aseptic loosening for 16.2% and instability for 13.2%. PJI was the most common indication at any time of revision with 43.8% up to one, 35.4% 1–3 years and 39.4% more the 3 years after index operation.The odds ratios in repeated revision were 2.32 times higher (p = 0.000) for PJI. For instability and retropatellar arthrosis the odds ratios were 0.60 times (p = 0.006) and 0.22 times (p = 0.000) lower.ConclusionsPJI is the most common indication for secondary TKA revision and within one year after primary TKA. Aseptical failures such as instability, retropatellar arthrosis and aseptical loosening are the predominant reasons for revision more than one year after primary TKA.

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Section: Methodsmentioning

confidence: 99%

Periprosthetic infection is the major indication for TKA revision – experiences from a university referral arthroplasty center

Boelch

Jakuscheit

Doerries

et al. 2018

BMC Musculoskelet Disord

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“…TIPP Es ist empfehlenswert, einen strukturierten Ablauf für schmerzhafte Endoprothesen zu implementieren und standardisiert abzuarbeiten, um bei der Vielzahl von möglichen Ursachen eine möglichst hohe diagnostische Sicherheit zu erzielen [14].…”

Section: Kernspintomografieunclassified

Revisionsendoprothetik des Kniegelenks

Kremer¹,

Gramlich²,

Hoffmann³

2020

Z Orthop Unfall

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ZusammenfassungDie Kombination aus steigender Lebenserwartung, Zunahme der Risikofaktoren für eine Gonarthrose gepaart mit hohem funktionellem Anspruch bis ins hohe Lebensalter führt zu einer Zunahme der Implantationszahlen primärer Knieendoprothesen. Folglich nimmt auch die Häufigkeit von Revisionseingriffen drastisch zu. Klare Konzepte sind notwendig, um gute Ergebnisse zu erzielen. Dieser Artikel gibt einen Überblick über die aktuellen Strategien der Revisionsendoprothetik des Kniegelenks.

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“…Medical imaging of the TKA plays an important role in identifying the cause(s) of dissatisfaction. During the past decade, several differential diagnostic algorithms for the problematic TKA have been developed as a result of a multitude of studies [3,[7][8][9]. In all these differential diagnostic algorithms several additional imaging investigations such as CT, SPECT-CT, stress radiographs or other are used.…”

Section: Introductionmentioning

confidence: 99%

The diagnostic potential of low-field MRI in problematic total knee arthroplasties - a feasibility study

et al. 2020

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Purpose: Low-field MRI, allowing imaging in supine and weight-bearing position, may be utilized as a non-invasive and affordable tool to differentiate between causes of dissatisfaction after TKA ('problematic TKA'). However, it remains unclear whether low-field MRI results in sufficient image quality with limited metal artefacts. Therefore, this feasibility study explored the diagnostic value of low-field MRI concerning pathologies associated with problematic TKA's' by comparing low-field MRI findings with CT and surgical findings. Secondly, differences in patellofemoral parameters between supine and weight-bearing low-field MRI were evaluated. Methods: Eight patients with a problematic TKA were scanned using low-field MRI in weight-bearing and supine conditions. Six of these patients underwent revision surgery. Scans were analysed by a radiologist for pathologies associated with a problematic TKA. Additional patellofemoral and alignment parameters were measured by an imaging expert. MRI observations were compared to those obtained with CT, the diagnosis based on the clinical work-up, and findings during revision surgery. Results: MRI observations of rotational malalignment, component loosening and patellofemoral arthrosis were comparable with the clinical diagnosis (six out of eight) and were confirmed during surgery (four out of six). All MRI observations were in line with CT findings (seven out of seven). Clinical diagnosis and surgical findings of collateral excessive laxity could not be confirmed with MRI (two out of eight). Conclusion: Low-field MRI shows comparable diagnostic value as CT and might be a future low cost and ionizing radiation free alternative. Differences between supine and weight-bearing MRI did not yield clinically relevant information. The study was approved by the Medical Research Ethics Committees of Twente (Netherlands Trial Register: Trial NL7009 (NTR7207). Registered 5 March 2018, https://www.trialregister.nl/trial/7009).

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Berliner diagnostischer Algorithmus der schmerzhaften Knie-TEP

Cited by 20 publications

References 62 publications

Periprosthetic infection is the major indication for TKA revision – experiences from a university referral arthroplasty center

Periprosthetic infection is the major indication for TKA revision – experiences from a university referral arthroplasty center

Revisionsendoprothetik des Kniegelenks

The diagnostic potential of low-field MRI in problematic total knee arthroplasties - a feasibility study

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