Knee instability as the primary cause of failure following Total Knee Arthroplasty (TKA): A systematic review on the patient, surgical and implant characteristics of revised TKA patients

Wilson, Christopher J.; Theodoulou, Annika; Damarell, Raechel; Krishnan, Jeganath

doi:10.1016/j.knee.2017.08.060

Cited by 64 publications

(41 citation statements)

References 30 publications

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“…A total of 68.8% of the revision knee arthroplasties were performed on female patients, which roughly correlate with figures in our literature review. 11 This might suggest a higher risk of revision for female patients. Similarly, in the 2015 AOANJRR report data, females made up 56% of all primary Table 6 Types of revision knee arthroplasty total number and percentages at our center from April 2014 to December 2015 compared with percentages in national data from AOANJRR 2015 annual report (Table KT7) TKA procedures performed, thus placing more females "at risk" of revision surgery.…”

Section: Discussionmentioning

confidence: 99%

Design, Construction, and Early Results of a Formal Local Revision Knee Arthroplasty Registry

et al. 2020

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National registries for primary and revision knee arthroplasty in Australia, New Zealand, and Europe have been successful in ensuring quality control and providing information to drive crucial research. However, they face challenges in delivering the granularity of data useful at a local hospital level. Our aim was to address these challenges by designing and initiating a local revision knee arthroplasty registry and combining the data with national figures to better evaluate the types of revisions undertaken, and improve patient outcomes and care. All revision knee arthroplasty cases in our center were analyzed from April 2014 to December 2015 using our standardized diagnostic algorithm. Information such as reason and type of revision was collected. Results were compared with Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data. Primary outcome was comparison against our center's historical data between January 1999 and December 2013 and secondary outcome was comparison against national data prior to and after our intervention. Between April 2014 and December 2015, our center performed 35 revision knee arthroplasties. When compared with our center's historical data, we observed lower rates of revision knee arthroplasties due to “pain” (14.2 vs. 36.7%) with corresponding lower rates of patella button only revision (8.6 vs. 39.2%). Compared with national data before our intervention, we had lower revision rates from infection (14.2 vs. 22.3%) and loosening/lysis (11.4 vs. 29.2%). We undertook more minor revisions (45.7 vs. 30.5%) and similar total revisions (25.7 vs. 25.3%). Similar trends were seen in comparison to national data after our intervention. Our study shows that a local registry can be designed and successfully implemented for revision knee arthroplasty surgery. Data can be easily compared with historic and current hospital and national registry data trends to assess quality and robustness of revision arthroplasty programs. Our early results suggest our center has succeeded in reducing incidences of major revisions, complications, and the risk of re-revision surgery. This will improve the quality of our service with a significant cost reduction for our local health care budget.

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Section: Discussionmentioning

confidence: 99%

Design, Construction, and Early Results of a Formal Local Revision Knee Arthroplasty Registry

et al. 2020

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“…Similarly, the TKA occurs away from the neurovascular bundle and therefore there should be no change in vascular anatomy of the peroneal vessels. The overall complication rate for TKA is 2% or less, 8 with instability being a major cause of failure 12,13 . Even in cases of failure, orthopedic surgeons have reported successful use of the contralateral FFF to reinforce an infected TKA and reconstruct the knee 14 …”

Section: Discussionmentioning

confidence: 99%

Safety of fibula free flap in patients following total knee replacement

et al. 2020

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Background: Fibula free flap (FFF) is the preferred osteocutaneous flap for reconstruction of large head and neck composite defects. There is a paucity of data whether FFF can be performed safely in patients with knee replacement (total knee arthroplasty [TKA]). Methods: Multi-institutional review of outcomes following FFF in patients who had prior TKA. Results: Ten surgeons reported successful FFF in 53 patients with prior TKA. The most common preoperative imaging was a CT angiogram of the bilateral lower extremities. There was no evidence of intraoperative vascular abnormality. Physical therapy began between postoperative day 1 to postoperative day 3. At 1 month postoperatively, 40% of patients were using a cane or walker to ambulate, but by 3 months all had returned to baseline ambulatory status. At >1 year, there were no gait complications. Conclusion: FFF appears safe in patients with prior knee replacement without an increased risk of complications compared to baseline.

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“…MARS MRI or metal ion levels are not done routinely in knees due to the nature of metal on polyethylene articulation but are important as it will help diagnose hidden etiologies for implant failure, as seen here. A treatment algorithm indicating an approach to a patient with painful instability is available but may need an update based on these findings [10-11]. Extensive debridement to remove the dead necrotic tissues is necessary.…”

Section: Discussionmentioning

confidence: 99%

Elusive Differential of a Painful Unstable Total Knee Arthroplasty – Metal on Cement Disease

Jagadale

2019

Cureus

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Particle disease from the release of metal, cement, ceramic, or polyethylene particles is a rare condition in total knee replacement. Wear, fracture, or corrosion of the components leads to foreign body reaction in the joint, followed by pain, swelling, limited motion, difficulty in walking, functional disability, and occasional systemic disease. This paper presents two cases of metal-on-cement disease as an etiology for the implant failure wherein the metal particles were shed off from the implant, along with cement and polyethylene particles, leading to a complex foreign body reaction in the failed total knee. We have coined this phenomenon as "cementallosis." Initial symptoms and signs from implant failure in both patients were mild, intermittent mediolateral knee pain that was aggravated after walking but no pain at rest or at night. The pain was associated with a 'buckling' sensation, recurrent knee swelling, and gradually worsening knee range of motion. Clinical examination in both cases was suggestive of a wellhealed anterior midline surgical scar, mild to moderate effusion, mild diffuse tenderness over the entire joint, limited functional range of motion, grade 1+ laxity throughout the range of motion, and intact distal neurovascular status. Routine blood and synovial fluid workup were inconclusive for identifying the exact etiology of the patient's symptoms. Radiographs, computed tomography (CT) scans, as well as bone scans, were negative for prosthetic joint infection, component malalignment, polyethylene wear, maltracking, or loosening of the components but showed mild to moderate effusions, synovial hypertrophy, and mild scattered periprosthetic osteolysis. Intraoperatively, there was significant synovial hypertrophy with dark pigment deposition and apparent dissociation of the femoral and tibial components from the underlying cement mantle, although the cement was well-adhered to the underlying bone. Synovial fluid and multiple tissue specimens were suggestive of complex foreign body granulomas with metal, cement, and polyethylene particles. These patients had undergone surgery by the same surgery team in the community using the same implant. These cases demonstrate the failure of a total knee arthroplasty implant at the metal-cement interface with features of adverse local tissue reactions that resemble a pseudotumor from the metal-on-metal disease in the knee joint. We have compared and contrasted the clinical presentations, laboratory, imaging, histopathological, and intraoperative study findings in these cases. Knowing what to look for will aid in early diagnosis, ordering necessary investigations, better surgery planning, reducing operative time, as well as improving outcomes and cost of care. The aim of this paper is to educate the audience about this new phenomenon as a cause of knee prosthesis failure produced by a complex pseudotumor-like foreign body reaction that involves metal, cement, and polyethylene particles.

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Knee instability as the primary cause of failure following Total Knee Arthroplasty (TKA): A systematic review on the patient, surgical and implant characteristics of revised TKA patients

Cited by 64 publications

References 30 publications

Design, Construction, and Early Results of a Formal Local Revision Knee Arthroplasty Registry

Design, Construction, and Early Results of a Formal Local Revision Knee Arthroplasty Registry

Safety of fibula free flap in patients following total knee replacement

Elusive Differential of a Painful Unstable Total Knee Arthroplasty – Metal on Cement Disease

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