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18 Causes and Diagnosis of Aseptic Loosening After Total Knee Replacement

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The Unhappy Total Knee Replacement

Abstract

Aseptic loosening after TKR is the most common cause of late failure and revision. The main culprit of aseptic loosening is increased wear of early generation polyethylene, especially in thin and low-conformity inserts, associated with some implant designs such as discontinuous porous-coating cementless components. Additionally, surgical factors such as malalignment, malposition, and uncorrected instability may contribute to aseptic loosening. It is crucial to maintain the integrity of the implant-bone interface to avoid debris penetration into the bone. Counseling of patients at risk, particularly young and active individuals with elevated body mass index, should play a role on the prevention of this condition. When aseptic loosening is the cause of an unsatisfactory outcome and warrants revision, a detailed history, physical exam, and additional test should be obtained thoroughly to avoid misdiagnosis and adverse revision results.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, 19107, USA

    Carlos Higuera MD

  2. Department of Adult Reconstruction, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA

    Javad Parvizi MD, FRCS (Prof.)

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  1. Carlos Higuera MD
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Correspondence to Carlos Higuera MD .

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Editors and Affiliations

  1. Dept. Orthopaedic Surgery & Traumatology, Knee Surgery Unit, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland

    Michael T. Hirschmann

  2. Dept. Orthopaedics & Traumatology, Hospital Brandenburg, Brandenburg/Havel, Germany

    Roland Becker

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Higuera, C., Parvizi, J. (2015). 18 Causes and Diagnosis of Aseptic Loosening After Total Knee Replacement. In: Hirschmann, M., Becker, R. (eds) The Unhappy Total Knee Replacement. Springer, Cham. https://doi.org/10.1007/978-3-319-08099-4_23

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  • DOI: https://doi.org/10.1007/978-3-319-08099-4_23

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