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Review
. 2014 Aug;6(3):179-86.
doi: 10.1111/os.12123.

How to interpret postoperative X-rays after total knee arthroplasty

Nishikant Kumar  1 , Chandrashekhar Yadav, Rishi Raj, Sumit Anand
Affiliations
Review

How to interpret postoperative X-rays after total knee arthroplasty

Nishikant Kumar et al. Orthop Surg. 2014 Aug.

Abstract

Today, total knee arthroplasty (TKA) is one the most commonly performed surgeries worldwide. The purpose of this article is to review the appearance of normal post-TKA roentgenographs and describe the correct sequence for their interpretation. It is unwise to depend solely on patients' symptoms when diagnosing TKA complications because serial radiographs can foresee failures well before they manifest clinically. Ideal post-TKA radiographs comprise whole lower extremity anteroposterior and lateral views taken under weight bearing conditions along with a skyline view of the patellofemoral joint. Among other things, weight bearing exposes the true alignment, ligamentous laxity and polyethylene wear. On the basis of follow-up of our TKA cases, we have drawn up a protocol for assessing postoperative X-ray films after TKAs. Following the proposed sequence, surgeon can easily decide how to proceed with follow-up and foresee complications. Careful interpretation of postoperative radiographs after TKA is essential to careful monitoring of patients and implant survival.

Keywords: Arthroplasty; Interpretation; Knee; Roentgenography.

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Figures

Figure 1
Figure 1
Long tibial cemented insert (with stem extender) for occult fracture of proximal tibia (the occult fracture is indicated by the arrow).
Figure 2
Figure 2
Postoperative radiograph of TKR showing MDFA of 95° and MPTA of 85°. The tibial angle here is suboptimal.
Figure 3
Figure 3
Lateral view showing Grade II notching of anterior femoral cortex.
Figure 4
Figure 4
Diagrammatic depiction of measurement of posterior condylar offset (A) before surgery and (B) after surgery. A Should be equal to B to prevent mid flexion instability.
Figure 5
Figure 5
Lateral view of postoperative TKR showing restoration of posterior condylar offset.
Figure 6
Figure 6
Insall–Salvati ratio (P/LP) and Canton–Deshamps index (AP/AT) for assessing patellar height.
Figure 7
Figure 7
Postoperative anteroposterior, lateral and skyline views of TKA showing good alignment.
Figure 8
Figure 8
Different cement zones on femoral and tibial sides.
Figure 9
Figure 9
Osteolysis around the tibial tray (arrows).
Figure 10
Figure 10
Merchant view showing patellar subluxation following TKA.
Figure 11
Figure 11
Disruption of patellar component with posterior suluxation of patella (high riding patella; chip avulsion from tibial tuberosity).
Figure 12
Figure 12
Postoperative radiograph showing Rader class III HO (arrows).
See this image and copyright information in PMC

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