ICJR REWIND: Why Did These TKAs Fail?

    Understanding the variety of failure modes for total knee arthroplasty (TKA) will help the orthopaedic surgeon diagnose and recommend appropriate treatment when a patient complains of pain or other issues following a primary procedure. It can also help the surgeon avoid complications in the future.

    At ICJR’s 10th Annual Winter Hip & Knee Course, Bryan D. Springer, MD, from OrthoCarolina in Charlotte, North Carolina, moderated a case-based panel discussion that featured 5 failed TKAs. Faculty presented their cases, solicited feedback from the panel members, and then revealed how the cases resolved.

    As our panel demonstrated, even the most experienced orthopaedic surgeons have patients whose knee replacements fail.

    Case 1: Infection
    Case presented by Matthew S. Austin, MD, The Rothman Institute, Philadelphia, Pennsylvania

    • 64-year-old female
    • Had undergone a right TKA
    • Suture abscess noted at the 2-week postoperative visit
    • Patient afebrile and otherwise progressing well
    • Cephalexin prescribed

    Case 2: Flexion Instability
    Case presented by Walter B. Beaver Jr., MD,
    OrthoCarolina, Charlotte, North Carolina

    • 61-year-old male with varus deformity of the left knee
    • Preoperative exam: Range of motion 10 to 100, hip motion normal with no pain, no back issues, neurovascularly intact
    • 6 months after surgery: Swelling and blood effusion
    • Labs negative for infection

    Case 3: Patellar Instability
    Case presented by Daniel J. Berry, MD, Mayo Clinic, Rochester, Minnesota

    • 61-year-old male
    • Weight: 300 pounds; BMI: 44
    • Primary TKA done 1 year earlier at another institution
    • Patellar revision/medial reefing done 6 months earlier at another institution
    • Current complaint of the leg “giving way”
    • Osteoarthritis in the contralateral knee as well
    • Preoperative exam: Range of motion 110 flexion, reasonable tibiofemoral stability, patella dislocates in flexion

    Case 4: Failed ORIF Complicated by Vascular Injury
    Case presented by David G. Lewallen, MD, Mayo Clinic, Rochester, Minnesota

    • 50-year-old male
    • Gunshot wound to the right distal femur, with neurovascular injury, 23 years prior
    • Primary TKA with hinged prosthesis 20 years prior
    • Periprosthetic femoral fracture at the stem tip 1 year prior
    • Open reduction closed fixation (ORIF) performed at another institution
    • Presents with pain at rest, varus deformity, inability to bear weight
    • Radiographs: Profusion of hardware, failure of fracture to unite

    Case 5: Aseptic Loosening
    Case presented by Michael J. Taunton, MD, Mayo Clinic, Rochester, Minnesota

    • 66-year-old female with varus right knee
    • BMI: 38
    • Significant surgical history: Revision left TKA for aseptic loosening 1.5 years after the primary procedure
    • Undergoes right primary TKA; small implants used: size 2 femur, size 1 tibia
    • Presents 2.5 years after right primary procedure with symptoms of loosening
    • Labs negative for infection

    Click the image above to watch the presentation and find out how the panel members would manage these patients and how the cases were eventually resolved.

    This article was originally published on ICJR.net on August 6, 2018.

    Disclosures: The faculty have no disclosures relevant to this article.