Mechanical complications after total knee arthroplasty

ABSTRACT

Introduction

With the increasing demand for total knee arthroplasty (TKA) and the burden of revision TKA on the healthcare system, as well as the quality of life implications for patients, it is extremely important for surgeons to be able to anticipate and prevent TKA mechanical complications. Surgeons must be familiar with the different causes and mechanisms of TKA complications so that they can properly treat patients with failed TKAs and better avoid these complications.

Areas covered

This review addresses TKA mechanical complications and provides context for the topic. A detailed review of surgical factors, implant factors, and patient factors that contribute to mechanical complications after TKA is provided. All of the literature cited in this review was gathered from the PubMed online database using different keywords based on the section of the manuscript.

Expert opinion

As surgeons and engineers solve certain issues in TKA, new challenges will inevitably arise. We must continue to push forward and innovate from both a surgical technique and implant design perspective.

KEYWORDS:

• Total knee arthroplasty
• implant design
• revision total knee arthroplasty
• implant malalignment
• implant malposition
• mechanical complications
• mechanical failure
• aseptic loosening

Article highlights

• Given that the number of TKAs performed every year is growing rapidly, as well as the heavy burden on the healthcare system and poor patient outcomes associated with revision TKA, it is extremely important to analyze reasons for mechanical complications after TKA.

• TKA implants are recalled due to either device design or process control issues.

• Component sizing, positioning, method of fixation, and implant design details are all key factors that can contribute to the success or failure of a TKA.

• Patient risk factors such as increased BMI, young age, smoking, and diabetes increase the rate of mechanical complications after TKA.

• The amount of innovation and technology being poured into TKA is extremely exciting.

• Increased demand for TKA in younger, heavier, and more active patients presents new challenges that surgeons and engineers will tackle in the next 10–20 years.

Declaration of interest

R Schwarzkopf has stock or stock options with Gauss surgical; is a paid consultant for and has stock or stock options with Intellijoint; has stock or stock options with PSI; has IP royalties, is a paid consultant for and has received research support from Smith & Nephew; and is a paid consultant for Zimmer.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.