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TKA Revision
Posted: May 9 2023 #(C102182)
A

Painful TKA with Recurrent Tibial Loosening in 62F

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Painful TKA with Recurrent Tibial Loosening in 62F

HPI

A 62-year-old female with a history of two prior revisions of her left total knee presents with persistent pain, swelling, buckling, and difficulty bending her knee. She has trouble with prolonged weight bearing and requires a cane. She has pain initially when walking, followed by a period of pain free ambulation, then severe pain with prolonged walking. Her primary left TKA done in 2019. She had a subsequent revision for femoral loosening in Oct 2019, and a 2rd revision for tibial loosening in Nov 2020. Previous work up for infection, including preoperative aspiration, has been negative. CRP: <4.0 mg/L, ESR: 15 mm/h. Aspiration showed 591 WBC with 77% neutrophils. Cultures remained negative. Allergy testing has also been negative. Assessment based on clinical presentation and imaging concluded a loose tibial component with a stable femoral component.

PMH

PMH is unremarkable.

PE

She walks with an antalgic gait. She has neutral alignment. She has a well healed midline incision. There is no effusion or warmth. There is no gross varus/valgus or AP instability. ROM 0-120. NVI distally. She has normal pain free hip ROM.

Poll
1 of 1
1. If you choose Revision Arthroplasty of the Tibial Component Alone with a Long-Stem (Diaphyseal) Tibial Prosthesis, what would be your fixation strategy of the tibia?
I would not choose Revision Arthroplasty of the Tibial Component Alone with a Long-Stem (Diaphyseal) Tibial Prosthesis
5%
21/351
    • Pressfit Alone
    1%
    5/351
    • Pressfit + Impaction Grafting
    2%
    9/351
    • Pressfit + Cone/Sleeve
    12%
    43/351
    • Pressfit + Impaction Grafting + Cone/Sleeve
    11%
    41/351
    • Cement Fixation Alone
    5%
    21/351
    • Cement Fixation + Impaction Grafting
    5%
    20/351
    • Cement Fixation + Cone/Sleeve
    32%
    113/351
    • Cement Fixation + Impaction Grafting + Cone/Sleeve
    13%
    48/351
    • Outside my area of expertise - best if I don't vote
    8%
    30/351
    • PROCEDURE #1 DOP: 5/1/2023

    Revision Knee Arthroplasty of the Tibial Component Alone with Impaction Bone Grafting, Cone, and Cement

    Intra-procedure P1
    icon
    OUTCOMES
    -12 days after
    Post-procedure P1
    POLL#
    Surgeon's Choices
    1
    In addition to AP and Lat radiographs of the femur, tibia, and knee, would you obtain any further imaging to guide your treatment?
    Yes - CT scan
    2
    Would you obtain a Bone Scan to help guide management in this patient?
    Yes - I would obtain a bone scan
    3
    If you obtained an aspirate to rule out infection, would you send the sample for molecular workup (DNA, RNA, Alpha Defensin) to rule out infection?
    No - I would not send for molecular workup
    4
    If you choose Operative Management, what treatment would you perform?
    Revision Knee Arthroplasty
    5
    If you choose Revision Knee Arthroplasty, what components would you revise?
    Tibia Alone
    6
    If you choose Revision Arthroplasty of the Tibial Component Alone with a Long-Stem (Diaphyseal) Tibial Prosthesis, what would be your fixation strategy of the tibia?
    Cement Fixation + Impaction Grafting + Cone/Sleeve
    10
    If you performed the operation shown, what would be your immediate weight-bearing protocol?
    Partial (25%) weight-bearing
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