Prodromes of failure in total knee arthroplasty

A total of 102 revision total knee arthroplasties (TKAs) were reviewed to determine the prodromal symptoms and radiographic findings associated with failure. Presenting symptoms included pain (84%); swelling (76%); progressive varus or valgus deformity (19%); instability (17%); stiffness (17%); clicking or grinding (7%); catching (4%); and patellar pain, subluxation, or clicking (4%). Radiographs were diagnostic in 91% of cases, demonstrating complete radiolucencies (80%), polyethylene wear (43%), component breakage (5%), metallic debris (3%), patellar subluxation or dislocation (4%), and osteolysis (4%). Gross intraoperative findings included polyethylene wear (72%), osteolysis (22%), metal-wear synovitis (9%), component breakage (6%), patellar wear and dissociation (4%), and occult sepsis (5%). The average duration of symptoms was 13 months; the interval between orthopedic evaluations averaged 23 months. Based on this information, we recommend that an annual questionnaire and weight-bearing radiographs be used to ensure adequate surveillance of TKA patients and avoid complications associated with delay in diagnosis of polyethylene wear or implant loosening.