Early mechanical failure in total knee arthroplasty

Early mechanical dysfunction of a total knee arthroplasty (TKA) is a challenging problem in terms of causality and solutions. The current strategy in our department is to perform a complete TKA revision rather than the less invasive partial procedures when a clear mechanical cause of failure has been found. In this investigation, we assessed 21 patients who underwent complete TKA revision in 2003-2004 in our institution within the first two years following the index TKA. Various clinical presentations included pain, stiffness, instability, and femoro-patellar signs. These corresponded to implant size, position, and fixation issues. The IKS knee score/function significantly increased from 47/47 to 85/78 at follow-up (six months minimum). Compared to the data in the literature, this systematic full revision seems to be a reasonable approach. This attitude takes advantage of the modularity of the implants for allowing perioperative adjustments of position, fixation, and constraint. Based on the results of our study, we propose a list of six mechanical pitfalls to be evaluated in the case of early dysfunction: frontal misalignment, sagittal overstuffing or malpositioning, axial malrotation, poor bone fixation, inappropriate constraint or ligamentous balance, and inappropriate level of the joint space.