Weight-bearing pain and implant migration, progressive radiolucencies, radiolucency more than 2 mm and subsidence on radiographs and CT are generally accepted criteria for knee arthroplasty loosening: An international Delphi consensus study.
CT
aseptic loosening
clinical signs
consensus
knee arthroplasty
radiographs
Journal
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Titre abrégé: Knee Surg Sports Traumatol Arthrosc
Pays: Germany
ID NLM: 9314730
Informations de publication
Date de publication:
10 Aug 2024
10 Aug 2024
Historique:
revised:
15
07
2024
received:
29
02
2024
accepted:
29
07
2024
medline:
10
8
2024
pubmed:
10
8
2024
entrez:
10
8
2024
Statut:
aheadofprint
Résumé
Establishing the diagnosis of loosening in total or unicondylar knee arthroplasty remains a challenge with different clinical and radiological signs evaluated in study designs with high risk of bias, where few or incomplete criteria are formulated for establishing the diagnosis of implant loosening. This study aimed at evaluating the variability between different clinical and radiological criteria and establish a consensus regarding clinical and radiological criteria for the diagnosis of knee arthroplasty loosening. Highly specialized knee surgeons focusing on revision arthroplasty were invited to take part in an international panel for a Delphi consensus study. In the first round, the participants were asked to state their most important clinical and radiological criteria for implant loosening. In a second round, the panel's agreement with the collected criteria was rated on a 5-point Likert scale (1-5). High variability was defined by receiving at least one score each indicating complete disagreement and complete agreement. Consensus was established when over 70% of participants rated a criterion as 'fully agree' (5) or 'mostly agree' (4). High variability was observed in 56% of clinical criteria and 38% of radiological criteria. A consensus was reached on one clinical (weight-bearing pain [82%]) and four radiological criteria, that is, implant migration, progressive radiolucencies, subsidence and radiolucencies >2 mm on X-ray or computed tomography (CT) (84%-100%). Amongst specialized knee revision surgeons, there is high variability in clinical and radiological criteria that are seen as important contributing factors to diagnosis of knee implant loosening. A consensus was reached on weight-bearing pain as clinical criterion and on implant migration, progressive radiolucencies, subsidence and radiolucencies of more than 2 mm on X-ray or CT as radiological criteria. The variability rates observed, along with the criteria that reached consensus, offer important insights for the standardization of diagnostic protocols. Level V.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : This study was funded by an internal TKI-PPP grant from the Amsterdam University Medical Centre. Allowance made available by Health-Holland, Top Sector Life Sciences & Health, to stimulate public-private partnerships
Informations de copyright
© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.
Références
Anzola, L.K., Hernandez, N., Rodriguez, L.F., Sanguino, G., Martinez, E., Lopez, R. et al. (2023) The role of SPECT/CT in painful, noninfected knees after knee arthroplasty: a systematic review and meta‐analysis—a diagnostic test accuracy review. Journal of Orthopaedic Surgery and Research, 18, 223. Available from: https://doi.org/10.1186/s13018-023-03687-8
Awengen, R., Rasch, H., Amsler, F. & Hirschmann, M.T. (2016) Symptomatic versus asymptomatic knees after bilateral total knee arthroplasty: what is the difference in SPECT/CT? European Journal of Nuclear Medicine and Molecular Imaging, 43, 762–772. Available from: https://doi.org/10.1007/s00259-015-3278-0
Barnsley, L. & Barnsley, L. (2019) Detection of aseptic loosening in total knee replacements: a systematic review and meta‐analysis. Skeletal Radiology, 48, 1565–1572. Available from: https://doi.org/10.1007/s00256-019-03215-y
Buijs, G.S., Kooijenga, A.C., Rikken, Q.G.H., Schafroth, M.U., Kievit, A.J. & Blankevoort, L. (2024) MRI and SPECT/CT demonstrate, with low certainty of evidence, the highest diagnostic accuracy for aseptic knee arthroplasty loosening; a systematic comparative diagnostic test review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 32, 2061–2074. Available from: https://doi.org/10.1002/ksa.12206
Dalury, D.F., Pomeroy, D.L., Gorab, R.S. & Adams, M.J. (2013) Why are total knee arthroplasties being revised? The Journal of Arthroplasty, 28, 120–121. Available from: https://doi.org/10.1016/j.arth.2013.04.051
Diamond, I.R., Grant, R.C., Feldman, B.M., Pencharz, P.B., Ling, S.C., Moore, A.M. et al. (2014) Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. Journal of Clinical Epidemiology, 67, 401–409. Available from: https://doi.org/10.1016/j.jclinepi.2013.12.002
Hochman, M.G., Melenevsky, Y.V., Metter, D.F., Roberts, C.C., Bencardino, J.T., Cassidy, R.C. et al. (2017) ACR Appropriateness Criteria® imaging after total knee arthroplasty. Journal of the American College of Radiology, 14, S421–S448. Available from: https://doi.org/10.1016/j.jacr.2017.08.036
Jünger, S., Payne, S.A., Brine, J., Radbruch, L. & Brearley, S.G. (2017) Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review. Palliative Medicine, 31, 684–706. Available from: https://doi.org/10.1177/0269216317690685
Kallala, R.F., Vanhegan, I.S., Ibrahim, M.S., Sarmah, S. & Haddad, F.S. (2015) Financial analysis of revision knee surgery based on NHS tariffs and hospital costs Does it pay to provide a revision service? The Bone & Joint Journal, 97–B, 197–201. Available from: https://doi.org/10.1302/0301-620X.97B2.33707
Kassam, A., Dieppe, P. & Toms, A. (2012) An analysis of time and money spent on investigating painful total knee replacements. Orthopaedic Proceedings, 94–B(Supplement_XXXIX), 234. Available from: https://doi.org/10.1302/1358-992X.94BSUPP_XXXIX.BOA2011-234
Klug, A., Gramlich, Y., Rudert, M., Drees, P., Hoffmann, R., Weißenberger, M. et al. (2021) The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years. Knee Surgery, Sports Traumatology, Arthroscopy, 29, 3287–3298. Available from: https://doi.org/10.1007/s00167-020-06154-7
Labek, G., Thaler, M., Janda, W., Agreiter, M. & Stöckl, B. (2011) Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. The Journal of Bone and Joint Surgery. British Volume, 93 B, 293–297. Available from: https://doi.org/10.1302/0301-620X.93B3.25467
Gademan, M.G.J., Van Steenbergen, L.N., Cannegieter, S.C., Nelissen, R.G.H.H. & Marang‐Van De Mheen, P.J. (2021) Population‐based 10‐year cumulative revision risks after hip and knee arthroplasty for osteoarthritis to inform patients in clinical practice: a competing risk analysis from the Dutch Arthroplasty Register. Acta Orthopaedica, 92, 280–284. Available from: https://doi.org/10.1080/17453674.2021.1876998
Mandalia, V., Eyres, K., Schranz, P. & Toms, A.D. (2008) Evaluation of patients with a painful total knee replacement. The Journal of Bone and Joint Surgery. British Volume, 90, 265–271. Available from: https://doi.org/10.1302/0301-620X.90B3.20140
Mathis, D.T., Hauser, A., Iordache, E., Amsler, F. & Hirschmann, M.T. (2021) Typical pain patterns in unhappy patients after total knee arthroplasty. The Journal of Arthroplasty, 36, 1947–1957. Available from: https://doi.org/10.1016/j.arth.2021.01.040
Mathis, D.T. & Hirschmann, M.T. (2021) Why do knees after total knee arthroplasty fail in different parts of the world? Journal of Orthopaedics, 23, 52–59. Available from: https://doi.org/10.1016/j.jor.2020.12.007
Mathis, D.T., Tschudi, S., Amsler, F., Hauser, A., Rasch, H. & Hirschmann, M.T. (2022) Correlations of typical pain patterns with SPECT/CT findings in unhappy patients after total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy, 30, 3007–3023. Available from: https://doi.org/10.1007/s00167-021-06567-y
Murer, A.M., Hirschmann, M.T., Amsler, F., Rasch, H. & Huegli, R.W. (2020) Bone SPECT/CT has excellent sensitivity and specificity for diagnosis of loosening and patellofemoral problems after total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy, 28, 1029–1035. Available from: https://doi.org/10.1007/s00167-019-05609-w
Robertsson, O., Ranstam, J., Sundberg, M., W‐Dahl, A. & Lidgren, L. (2014) The Swedish Knee Arthroplasty Register: a review. Bone & Joint Research, 3, 217–222. Available from: https://doi.org/10.1302/2046-3758.37.2000289
Röhner, E., Heinecke, M. & Matziolis, G. (2021) Diagnostic algorithm in aseptic TKA failure—what is evidence‐based? Journal of Orthopaedics, 24, 248–253. Available from: https://doi.org/10.1016/j.jor.2021.03.006
Walinga, A.B., Janssen, S.J., Kievit, A.J., de Borgie, C.A.J.M. & Kerkhoffs, G.M.M.J. (2024) Consensus on the definition and criteria for failure of surgical treatment in bacterial arthritis of a native joint: an international Delphi study. Knee Surgery, Sports Traumatology, Arthroscopy, 32, 235–242. Available from: https://doi.org/10.1002/ksa.12027
Walker, E.A., Fox, M.G., Blankenbaker, D.G., French, C.N., Frick, M.A., Hanna, T.N. et al. (2023) ACR Appropriateness Criteria® imaging after total knee arthroplasty: 2023 update. Journal of the American College of Radiology, 20, S433–S454. Available from: https://doi.org/10.1016/j.jacr.2023.08.014