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The failed total knee arthroplasty: evaluation and etiology
Mark H Gonzalez1, Anis O Mekhail
1Orthopedic Surgery, Cook County Hospital, Chicago, IL 60612, USA.
The Journal of the American Academy of Orthopaedic Surgeons
|December 24, 2004
Summary
Evaluating failed total knee arthroplasty involves understanding patient history and common failure causes like pain, stiffness, and instability. Diagnostic tools like imaging and aspiration help identify mechanical issues or infection.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Total knee arthroplasty (TKA) is a common procedure to alleviate knee pain and improve function.
- Despite high success rates, a subset of patients experience TKA failure, necessitating further evaluation and management.
Purpose of the Study:
- To outline the systematic evaluation process for patients presenting with failed total knee arthroplasty.
- To identify the common etiologies and diagnostic approaches for TKA failure.
Main Methods:
- Detailed patient history, including index arthroplasty and medical history.
- Clinical assessment focusing on pain, stiffness, and instability.
- Radiographic and nuclear imaging, and joint aspiration for suspected infection.
Main Results:
- Primary failure modes include pain (mechanical, infectious), postoperative stiffness, and instability.
- Mechanical pain often relates to loosening, component failure, or patellar issues.
- Infection, synovitis, or component loosening can cause persistent pain or loss of motion.
Conclusions:
- A thorough history and physical examination are crucial for diagnosing TKA failure.
- Imaging and aspiration are essential for identifying mechanical failures and infection, guiding revision strategies.