Early Detection Of Knee Revision Problems May Improve Outcomes: Study

More thorough follow-up exams and additional use of radiographs may help doctors detect knee implant problems following revision surgery, according to the findings of new research that suggest such efforts may result in better outcomes for patients who need additional procedures after a knee replacement. 

Researchers with the Thomas Jefferson University Hospital in Philadelphia published a study last month in Revision Total Knee Arthroplasty, which found that giving patients internet-based questionnaires, followed by radiographs if necessary could help identify occult failures. The study notes that patients often fail to follow up on their own when suffering early signs of knee failure or infections.

The study specifically looked at a number of previous studies on knee implants placed following revision surgery. According to the researchers, these replacement implants have a higher chance of failure than the original implant that had to be removed. Knee revision implants are nearly six times more likely to require additional revisions, the researchers note, with 12% failing at an average of 40 months.

The researchers indicate that often physicians follow up with the patients too infrequently, and some patients opt out of routine follow-ups due to inconvenience. In one earlier study, 45% of patients opted out of follow-up appointments due to inconvenience, such as lost wages, and expenditure of time.

The study indicates that providing patients with email or internet-based questionnaires, which are far more convenient, could lead to the identification of early signs of knee implant failures. These can be followed up by radiographs which can identify loosening, implant failures and infections.

“The potential value of Internet-based follow-up coupled with standing radiographs for identifying symptoms of mechanical failure cannot be overstated,” researchers wrote. “A number of patients whose implants are failing may deny knee symptoms that are reflective of implant failure, and this can only be reconciled by obtaining concurrent weightbearing radiographs of the knee.”

According to the findings, early identification can lead to early intervention, which can result in better outcomes of any additional surgeries that may be necessary.

The administration of periodic questionnaires and standing radiographs at intervals of 12–24 months can be an effective method of surveillance after revision total knee arthroplasty, particularly when there are obstacles to direct annual follow-up,” the researchers concluded. “The possibility that the presence of acute pain or swelling can be indicative of deep infection should not be overlooked, and patients with new symptoms should always be scrutinized and evaluated for sepsis or mechanical failure.”

The findings come amid a growing number of knee replacement lawsuits filed in recent months over problems associated with several different types of systems widely used in recent years, which have been linked to high rates of implant problems resulting in the need for knee revision surgery; including DePuy Attune Knee lawsuits,Exactech Optetrak Knee lawsuits, and Arthrex iBalance knee lawsuits.