Computed tomography evaluation of total knee arthroplasty implants position after two different surgical methods of implantation

Abstract Background Elective total knee arthroplasty (TKA) is a common surgery which has evolved rapidly. However, there are no recent large systematic reviews of serious adverse event (SAE) rate and 30-day readmission rate (30-dRR) or an indication of whether surgical methods have improved. Methods To obtain a pooled estimate of SAE rate and 30-dRR following TKA, we searched Medline, Web of Science, Cochrane Library, and Google Scholar databases. Data were extracted by two authors following PRISMA guidelines. Eligibility criteria were defined prior to a comprehensive search. Studies were eligible if they were published in 2007 or later, described sequelae of TKA with patient N > 1000, and the SAE or 30-dRR rate could be calculated. SAEs included return to operating room, death or coma, venous thromboembolism (VTE), deep infection or sepsis, myocardial infarction, heart failure or cardiac arrest, stroke or cerebrovascular accident, or pneumonia. Results Of 248 references reviewed, 28 are included, involving 10,153,503 patients; this includes 9,483,387 patients with primary TKA (pTKA), and 670,116 patients with revision TKA (rTKA). For pTKA, the SAE rate was 5.7% (95% CI 4.4−7.2%, I2 = 100%), and the 30-dRR was 4.8% (95% CI 4.3−5.4%, I2 = 100%). For rTKA, the SAE rate was 8.5% (95% CI 8.3−8.7%, I2 = 77%), while the 30-dRR was 7.2% (95% CI 6.4−8.0%, I2 = 81%). Odds of 30-dRR following pTKA were about half that of rTKA (OR 0.57, 95% CI 0.53−0.62%, p < 0.001, I2 = 45%). Of patients who received pTKA, the commonest SAEs were VTE (1.22%; 95% CI 0.83−1.70%) and genitourinary complications including renal insufficiency or renal failure (1.22%; 95% CI 0.83−1.67%). There has been significant improvement in SAE rate and 30-dRR since 2010 (χ2 test < 0.001). Conclusions TKA procedures have a relatively low complication rate, and there has been a significant improvement in SAE rate and 30-dRR over the past decade.

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Computed tomography analysis of knee pose and geometry before and after total knee arthroplasty

Journal of Biomechanics ◽

10.1016/j.jbiomech.2012.06.004 ◽

2012 ◽

Vol 45 (13) ◽

pp. 2215-2221 ◽

Cited By ~ 15

Author(s):

K.C.T. Ho ◽

S.K. Saevarsson ◽

H. Ramm ◽

R. Lieck ◽

S. Zachow ◽

...

Keyword(s):

Computed Tomography ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Before And After ◽

Total Knee ◽

Tomography Analysis

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Imaging of symptomatic total knee arthroplasty with cone beam computed tomography

Acta Radiologica ◽

10.1177/0284185118762247 ◽

2018 ◽

Vol 59 (12) ◽

pp. 1500-1507 ◽

Cited By ~ 3

Author(s):

Antti Jaroma ◽

Juha-Sampo Suomalainen ◽

Lea Niemitukia ◽

Tarja Soininvaara ◽

Jari Salo ◽

...

Keyword(s):

Computed Tomography ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Cone Beam Computed Tomography ◽

Tibial Component ◽

Cone Beam ◽

Component Rotation ◽

Symptomatic Knee ◽

Total Knee ◽

Component Loosening

Background Computed tomography (CT) can be used to assess the rotational alignment of prosthesis components to identify possible underlying causes of symptomatic total knee arthroplasty (TKA). The use of cone beam computed tomography (CBCT) for the imaging of extremities is relatively new, although it has been widely used in dental imaging. Purpose To assess the intra- and inter-observer reproducibility of CBCT, as well as to validate CBCT for TKA component and periprosthetic bone diagnostics. Material and Methods CBCT scans were performed on 18 patients the day before a scheduled revision TKA, from which the intra- and inter-observer reproducibility were assessed. Component rotation and loosening were evaluated. Perioperative bone defects were classified. Results The inter-observer intraclass coefficient correlation (ICC) for femoral component rotation was 0.41 (95% confidence interval [CI] = 0.12–0.69). For the tibial component, the ICC was 0.87 (95% CI = 0.74–0.94). Intra-observer reproducibilities were 0.70 (95% CI = 0.35–0.87) and 0.92 (95% CI = 0.80–0.97), respectively. The sensitivity for tibial component loosening was 97% and the specificity was 85%. The reliability of bone defect classification was only weak to moderate. Conclusion Two-dimensional (2D) CBCT scanning provides reliable and reproducible data for determining the rotation of femoral and tibial components, while showing minor overestimation of tibial component loosening. CBCT is a promising new tool for the evaluation of symptomatic knee arthroplasty patients, with a substantially lower radiation dose compared to conventional 2D multi-slice CT.

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Recurrent hemarthrosis after total knee arthroplasty in rheumatoid arthritis successfully treated with selective embolization: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x20964116 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2096411

Author(s):

Takeo Mammoto ◽

Toshiyuki Irie ◽

Nobuyuki Takahashi ◽

Shun Nakajima ◽

Atsushi Hirano

Keyword(s):

Rheumatoid Arthritis ◽

Computed Tomography ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Rare Complication ◽

Selective Embolization ◽

Acute Complications ◽

Genicular Artery ◽

Suprapatellar Pouch ◽

Total Knee

Recurrent hemarthrosis after total knee arthroplasty is a rare complication. This usually occurs in osteoarthritis, but is relatively rare in rheumatoid arthritis. This is a report of recurrent hemarthrosis after total knee arthroplasty in a rheumatoid arthritis patient. An 85-year-old woman with rheumatoid arthritis had received total knee arthroplasty without acute complications. At 6 months after surgery, the first hemarthrosis occurred and an initial conservative treatment failed. Contrast computed tomography showed prominent synovial enhancement in the superior lateral suprapatellar pouch. Selective catheterization revealed an abnormal hyperemic blush supplied from the branches of the superior lateral genicular artery. After embolization with N-butyl-2-cyanoacrylate, abnormal staining of the synovium diminished and knee swelling and pain disappeared without complications. Selective embolization is favorable for successful treatment of recurrent hemarthrosis after total knee arthroplasty in patients with rheumatoid arthritis.

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