title: Prodromes of failure in total knee arthroplasty.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Lonner
authors.forename: J M
authors.initials: JM
authors.lastname: Siliski
authors.forename: R D
authors.initials: RD
authors.lastname: Scott
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging; D007720:Knee Prosthesis; D008297:Male; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016474:Weight-Bearing