Work Up of the Painful Total Knee Arthroplasty



- See: TKR Menu:

- Early Failures:
    - in the report by Fehring TK, et al, the authors evaluated the causes of revision surgery;
          - between 1986 and 1999, 440 patients with TKR were referred for revision surgery;
          - of the 440 patients who had revision surgery, 279 (63%) had revision surgery within 5 years of their index arthroplasty:
          - 105 of the 279 patients with early failures (38%) had revision surgery because of infection;
          - 74 (27%) had revision surgery because of instability;
          - 37 (13%) had revision surgery because of failure of ingrowth of a porous-coated implant;
          - 22 (8%) had revision surgery because of patellofemoral problems;
          - 21 (7%) had revision surgery because of wear or osteolysis.
          - only eight of the 279 patients with early failures (3%) had revision surgery because of aseptic loosening of a cemented implant;
          - ref: Early Failures in Total Knee Arthroplasty
    - in the report by Scranton et al, the authors reviewed 33 patients who presented w/ persistent pain, inadequate knee motion, or both 
          after total knee arthroplasty;
          - of 33 patients, 26 had inadequate motion treated by closed manipulation, arthroscopic manipulation, or a modified open release 
                  manipulation;
          - in 23 patients, these procedures were successful;
          - of the 26 patients, 85% had a history of previous knee surgery or DM;
          - average gain in range of motion was not different in comparing early (<12 weeks) manipulation versus late (>12 weeks) manipulation;
          - 7 of the 33 patients presenting with pain, swelling, inadequate motion, or snapping sensations had either failure of bonding between
                 the polymethyl methacrylate and the components (4 patients) or painful fibrous intra-articular bands (3 patients);
                 - these patients were treated successfully either by recementing the components or by arthroscopic fibrous band release;
          - ref: Management of knee pain and stiffness after total knee arthroplasty.



Mechanisms of failure of the femoral and tibial components in total knee arthroplasty.

Radionuclide imaging of asymptomatic versus symptomatic total knee arthroplasties.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, May 10, 2012 4:03 pm