Causes of failure and etiology of painful primary total knee arthroplasty

Abstract

The review provides an overview of the causes of failure and the many different aetiologies of a painful primary total knee arthroplasty (TKA). They can be classified into extra- and intraarticular disorders, the latter being divided into biological and mechanical origins. Whereas biological aetiologies like infections have remained stable over time, other causes of failure have changed. In the early times of knee arthroplasty, they were mainly related to technical insufficiencies. A better understanding of knee arthroplasty, patients' increasing functional demands as well as a continuous development of TKA techniques generated newer problems, which are increasingly related to the functioning of the soft-tissue envelope of the knee. From a therapeutic point of view, three situations can be considered: functional problems not needing reoperations, causes of reoperations not needing an exchange of prosthetic components as well as reoperations with exchange of at least one prosthetic component.

Estimating the Burden of Total Knee Replacement in the United States

“…Such comparisons are limited because total knee replacement is not a chronic disease. However, similar to living with a chronic condition, undergoing elective surgery and living with a prosthetic implant lead to increased health-care utilization and carry small but clearly defined health risks, including joint infection, periprosthetic fracture, symptomatic implant loosening, and implant wear 11 . While annual rates of these adverse outcomes are low, with millions of adults in the U.S. living with total knee replacement over a prolonged period, these complications pose a potentially large public health burden.…”

“…Because of their continued disability, individuals with pain after total knee replacement may have low levels of physical activity and be at a heightened risk of death due to other comorbidities compared with the general population 32 . Moreover, patients with osteoarthritis who have a total knee replacement may experience pain of a type that is more difficult to diagnose and treat than that in patients without a total knee replacement 11,33 . Given that total knee replacement recipients represent over one-third of adults in the U.S. with diagnosed, symptomatic knee osteoarthritis, refining diagnostic and treatment algorithms should be a priority.…”

“…However, individuals who undergo total knee replacement are at risk for a variety of complications, such as infection, periprosthetic fracture, symptomatic implant loosening, and implant wear leading to mechanical failure 9,10 . These complications substantially diminish the benefits of total knee replacement and often necessitate revision surgery 11 . Growth in total knee replacement utilization has been disproportionately high among younger individuals (forty-five to sixty-four years old) [12][13][14] .…”

Metal artefact reduction in MRI at both 1.5 and 3.0 T using slice encoding for metal artefact correction and view angle tilting

“…In this context, MRI is supposed to be the imaging modality of choice for such applications because it has superior soft-tissue contrast. [1][2][3] However, the diagnostic accuracy and efficiency of MRI has been compromised by the susceptibility artefacts caused by metal implants. 4,5 Briefly, susceptibility artefacts result from local inhomogeneity of the main magnetic field, which will cause spin dephasing and frequency shifting of the tissue structures surrounding the metal implants.…”

Sagittal placement of the femoral component in total knee arthroplasty predicts knee flexion contracture at one-year follow-up

“…However, the results of this study do not show any correlation between implant size and flexion contracture 12 months postoperatively. A possible explanation might be that the flexion contracture is more correlated to a mismatch between the distal femoral anatomy and the implant size [29,30] than to the implant size itself.…”