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. 2008 Feb;32(1):53-6.
doi: 10.1007/s00264-006-0276-7. Epub 2006 Nov 21.

Early mechanical failure in total knee arthroplasty

Marc-Antoine Rousseau  1 , Jean-Yves Lazennec, Yves Catonné
Affiliations

Early mechanical failure in total knee arthroplasty

Marc-Antoine Rousseau et al. Int Orthop. 2008 Feb.

Abstract
in English, French

Early mechanical dysfunction of a total knee arthroplasty (TKA) is a challenging problem in terms of causality and solutions. The current strategy in our department is to perform a complete TKA revision rather than the less invasive partial procedures when a clear mechanical cause of failure has been found. In this investigation, we assessed 21 patients who underwent complete TKA revision in 2003-2004 in our institution within the first two years following the index TKA. Various clinical presentations included pain, stiffness, instability, and femoro-patellar signs. These corresponded to implant size, position, and fixation issues. The IKS knee score/function significantly increased from 47/47 to 85/78 at follow-up (six months minimum). Compared to the data in the literature, this systematic full revision seems to be a reasonable approach. This attitude takes advantage of the modularity of the implants for allowing perioperative adjustments of position, fixation, and constraint. Based on the results of our study, we propose a list of six mechanical pitfalls to be evaluated in the case of early dysfunction: frontal misalignment, sagittal overstuffing or malpositioning, axial malrotation, poor bone fixation, inappropriate constraint or ligamentous balance, and inappropriate level of the joint space.

L’échec mécanique précoce d’une prothèse totale du genou (PTG) pose des problèmes difficiles en termes d’analyse des causes et des solutions chirurgicales possibles, notamment par réintervention partielle. Notre stratégie actuelle est de réaliser un changement complet de la prothèse (RPTG) lorsqu'au moins une cause mécanique a été mise en évidence, de façon claire. Dans cette étude 21 cas de RPTG précoce ont été analysés. Sur le plan clinique ces patients présentaient tous des douleurs associées de raldeur, instabilité ou de signes fémoro-patellaires. Ceux-ci correspondaient toujours à un défaut technique initial. Les scores IKS genou et fonction ne sont améliorés de façon importante après la révision compléte, passant de 47/47 à 85/78 à six mois minimum d'évolution. La comparison de nos résultats avec les données de la littérature sur les révisions partielles a montré que notre attitude radicale était raisonnable. Après cette étude, nous proposons 6 pièges mécaniques qui doivent ètre recherchés lorsque l'on se trouve confronté à un dysfonctionnement précoce de PTG: le un mal positionnement des implants dans le plan frontal, un mal positionnement ou un excés d'encombrement dans le plan sagittal, une mal rotation axiale des pièces, un défaut de fixation pour les prothèses scellées, l'utilisation d'un degré de contrainte inapproprié, enfin, un trouble lié a la hauteur de l'interligne articulaire (rotule).

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Figures

Fig. 1
Fig. 1
Example of multi-factorial cause of early mechanical failure: a varus of the tibial implant, b negative sacral slope and patella bara, c internal rotation of the femoral implant, d internal rotation of the tibial implant
See this image and copyright information in PMC

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