ICJR CASES: Managing Revision Total Knee Arthroplasty Patients

    A 64-year-old male patient who is an avid tennis player presents with a complex surgical history: He’s undergone 3 right knee arthroscopies, a quadriceps rupture repair, and a primary right total knee arthroplasty (TKA). He had done well with the TKA over the past 3 years but has begun to experience pain and stiffness that is interfering with his ability to play tennis.

    On examination, he has a large effusion and limited range of motion (20° to 70°). The knee was aspirated but the culture was negative. The patient returns in a few weeks with worsening effusion, and the second aspirate cultures Salmonella.

    How would you approach a revision of this patient’s TKA?

    RELATED: Register for the 7th Annual Revision Hip & Knee Course

    This is 1 of 3 cases presented by William J. Long, MD, FRCSC, from NYU Langone Health, New York, New York, during a panel discussion on revision TKA at the ICJR East ISK Hip & Knee Course. Panel members included Raymond H. Kim, MD; William B. Macaulay Jr., MD; Andrea Baldini, MD; and Emmanuel Thienpont, MD, and during the session, they discussed how they would manage the following cases:

    Case 1

    • 58-year-old female patient who underwent bilateral primary TKA in 2008
    • Former professional dancer who was working as a dance instructor
    • Sudden pain in the right knee when demonstrating a bridge to her students
    • Experienced pain with using the stairs
    • Mild effusion on presentation
    • Knee stable in the varus/valgus plane but not in extension

    Case 2

    • 63-year-old female patient who had undergone TKA 13 months prior
    • No wound healing complications
    • Range of motion borderline initially
    • Experienced progressive stiffness and pain
    • Mild effusion and range of motion of 15° to 75°
    • Normal erythrocyte sedimentation rate and C-reactive protein level

    Case 3

    • 64-year-old male patient who had undergone multiple knee procedures: 3 arthroscopies of the right knee, quadriceps rupture repair 5 years prior, and right TKA 3 years prior
    • Complains of progressive pain and stiffness and difficulty playing tennis
    • Large effusion in the right knee and range of motion of 20° to 70°

    Click the image above to watch the presentation and find out what the expert panel members had to say about these cases and how the cases were resolved.