Current Modes of Failure in TKA: Infection, Instability, and Stiffness Predominate

Abstract

Background Historically, polyethylene wear and its sequelae (osteolysis, late instability, aseptic loosening) were common causes for revision total knee arthroplasty (TKA). Recently, polyethylene manufacturing has become more consistent; furthermore, a clearer understanding of the importance of oxidation on polyethylene performance led to packaging of the polyethylene bearings in an inert environment. This improved the quality and consistency of polyethylene used in TKA, raising the question of whether different failure modes now predominate after TKA.

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

“…One of the most devastating reasons for revision TKA is PJI, which has been found responsible for 16% to 27% of all revision TKAs in recent investigations [2,17,21,22]. PJI has also been implicated as the primary culprit in early revision (\2 years) [13,17,22].…”

“…PJI has also been implicated as the primary culprit in early revision (\2 years) [13,17,22]. Although various methods are used, two-stage exchange arthroplasty with an interim articulating or static antibiotic-laden bone cement spacer remains the gold standard for treating PJI in the United States.…”

“…One of the most devastating reasons for revision TKA is periprosthetic joint infection (PJI), representing 16% to 27% of all revision TKAs in recent series [2,4,6,16,17,21,22]. Although various surgical approaches for eradicating infection are used around the world, two-stage exchange arthroplasty is the gold standard for treating TKA PJI in the United States.…”

The implant infection paradox: why do some succeed when others fail? Opinion and discussion paper

“…Biomaterial-associated infections are the main cause of medical implant failure (Le et al, 2014), often requiring the total removal of the implant, aggressive debridement and a prolonged course of antibiotics. Infection-associated failure rates of implants vary depending on a number of factors, including: associated co-morbidities, presence of trauma, overall condition of patients, sterility of the wound and surgery, post-surgical care, material used and the surgical site.…”

Cochrane in CORR ®: Continuous Passive Motion Following Total Knee Arthroplasty in People With Arthritis (Review)

“…It is also one of the most commonly performed orthopaedic procedures [7]; one projection suggests that in the United States alone, more than 1.3 million TKAs will be performed per year by 2020 [12]. However, knee stiffness complicates approximately 1.3% of TKAs, severely limiting patients' function [11], reducing quality of life, and resulting in early revision [13].…”