Skeletal Radiology

, Volume 41, Issue 5, pp 493–501

How to read a postoperative knee replacement radiograph

  • Nawfal Al-Hadithy
  • Madhavan C. Papanna
  • Sana Farooq
  • Yegappan Kalairajah
Review Article

Abstract

Knee replacement surgery is the most common joint replacement surgery in England and Wales. Postoperative radiographs are associated with long-term outcome at both early and late stages, and their correct interpretation is therefore vital. These radiographs will commonly be assessed by surgical trainees, emergency doctors, orthopaedic surgeons, nurse practitioners, and radiologists. The aim of this paper is to provide the reader with a systematic approach to assessing these radiographs, whether it be in the immediate postoperative period or during subsequent follow-ups, and to provide sufficient knowledge to critique the procedure. An outline of prostheses and their indications alongside a comprehensive review of the assessment of important angles, alignment, and correct positioning of femoral and tibial components is presented.

Keywords

Knee radiograph Assessment Postoperative Replacement Arthroplasty 

References

  1. 1.
    National Joint Registry for England and Wales. 7th Annual report 2010. http://www.njrcentre.org.uk. 2010.
  2. 2.
    Bach CM, Mayr E, Liebensteiner M, Gstottner M, Nogler M, Thaler M. Correlation between radiographic assessment and quality of life after total knee arthroplasty. Knee. 2009;16:207–10.PubMedCrossRefGoogle Scholar
  3. 3.
    National Joint Registry for England and Wales. 7th Annual Report 2010. Prostheses used in hip and knee replacement procedures, 2009. http://www.njrcentre.org.uk. 2010.
  4. 4.
    McBride TJ, Prakash D. How to read a postoperative total hip replacement radiograph. Postgrad Med J. 2010. doi:10.1136/pgmj.2009.095620
  5. 5.
    Rowe PJ, Myles CM, Walker C, Nutton R. Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life? Gait Posture. 2000;12:143–55.PubMedCrossRefGoogle Scholar
  6. 6.
    Kurosaka M, Yoshiya S, Mizuno K, Yamamoto T. Maximizing flexion after total knee arthroplasty: the need and the pitfalls. J Arthroplast. 2002;17(4 Suppl 1):59–62.CrossRefGoogle Scholar
  7. 7.
    Phillips AM, Goddard NJ. Current techniques in total knee replacement: results of a national survey. Ann R Coll Surg Engl. 1996;78:515–20.PubMedGoogle Scholar
  8. 8.
    Hui FC, Fitzgerald JR. Hinged total knee arthroplasty. J Bone Joint Surg Am. 1980;62:513–9.PubMedGoogle Scholar
  9. 9.
    Inglis AE, Walker PS. Revision of failed knee replacements using fixed-axis hinges. J Bone Joint Surg Br. 1991;73-B:757–61.Google Scholar
  10. 10.
    Rand JA, Ilstrup DM. Survivorship analysis of total knee arthroplasty: cumulative rates of survival of 9,200 total knee arthroplasties. J Bone Joint Surg [Am]. 1991;73-A:397–409.Google Scholar
  11. 11.
    Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF. Rotating hinged total knee replacement: use with caution. J Bone Joint Surg [Am]. 2007;89:1735–41.CrossRefGoogle Scholar
  12. 12.
    Knutson K, Lindstrand A, Lidgren L. Survival of knee arthroplasties. nation-wide multicentre investigation of 800 cases. J Bone Joint Surg Br. 1986;68(5):795–803.PubMedGoogle Scholar
  13. 13.
    Petrou G, Petrou H, Tilkeridis C, Stavrakis T, Kapetsis T, Kremmidas N, et al. Medium-term results with a primary rotating hinge total knee replacement. J Bone Joint Surg Br. 2004;86-B:813–7.CrossRefGoogle Scholar
  14. 14.
    Kendrick BJ, Rout R, Bottomley NJ, Pandit H, Gill HS, Price AJ, et al. The implications of damage to the lateral femoral condyle on medial unicompartmental knee replacement. J Bone Joint Surg Br. 2010;92(3):374–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Pandit H, Gulati A, Jenkins C, Barker K, Price AJ, Dodd CA, Murray DW. Unicompartmental knee replacement for patients with partial thickness cartilage loss in the affected compartment. Knee. 2010;18(3):168–71.Google Scholar
  16. 16.
    Fisher DA, Dalury DF, Adams MJ, Shipps MR, Davis K. Unicompartmental and total knee arthroplasty in the over 70 population. Orthopedics. 2010;33(9):668.PubMedGoogle Scholar
  17. 17.
    National Joint Registry for England and Wales. 7th Annual report 2010. Surgical data to December 2009. http://www.njrcentre.org.uk. 2010.
  18. 18.
    Price AJ, Svard U. A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2011;469(1):174–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Heck DA, Marmor L, Gibson A, Rougraff BT. Unicompartmental knee arthroplasty. A multicentre investigation with long-term follow-up evaluation. Clin Orthop Relat Res. 1993;286:154–9.PubMedGoogle Scholar
  20. 20.
    Wolff AM, Hungerford DS, Pepe CL. The effect of extraarticular varus and valgus deformity on total knee arthroplasty. Clin Orthop Relat Res. 1991;271:35–51.PubMedGoogle Scholar
  21. 21.
    Kuano T, Urabe K, Miura H, Nagamine R, Matsuda S, Satomura M, et al. Importance of lateral anatomic tibial slope as a guide to the tibial cut in total knee arthroplasty in Japanese patients. J Orthop Sci. 2005;10:42–7.CrossRefGoogle Scholar
  22. 22.
    Werner FW, Ayers DV, Maletsky LP, Rullkoetter PJ. The effect of valgus/varus malalignment on load distribution in total knee replacements. J Biomech. 2005;38:349–55.PubMedCrossRefGoogle Scholar
  23. 23.
    Bellemans J, Banks S, Victor J, Vandenneucker H, Moermans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg. 2002;84:50–3.CrossRefGoogle Scholar
  24. 24.
    Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Why are total knee arthroplasties failing today? Clin Orthop. 2002;404:7–13.PubMedCrossRefGoogle Scholar
  25. 25.
    Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg. 1991;73:709–14.Google Scholar
  26. 26.
    Rand JA, Coventry MB. Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop. 1988;232:168–73.PubMedGoogle Scholar
  27. 27.
    Parratte S, Pagnano M, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg [Am]. 2010;92:2143–9.CrossRefGoogle Scholar
  28. 28.
    Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty. Just how important is it? J Arthroplasty. 200924(6 Suppl):39–43.Google Scholar
  29. 29.
    Keene G, Simpson D, Kalairajah Y. Limb alignment in computer-assisted minimally invasive unicompartmental knee replacement. J Bone Joint Surg Br. 2006;88(1):44–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Dutton AQ, Yeo SJ, Yang KY, Lo NN, Chia KU, Chong HC. Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. J Bone Joint Surg Am. 2008;90:2–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Petersen TL, Engh GA. Radiographic assessment of knee alignment after total knee arthroplasty. J Arthroplast. 1988;3:67–72.CrossRefGoogle Scholar
  32. 32.
    Maquet P. Biomecanique de la gonarthrose. Acta Orthop Belg. 1972;38(SupplI):S33–54.Google Scholar
  33. 33.
    Ritter MA, Faris PM, Keating EM. Anterior femoral notching and ipsilateral supracondylar femur fracture in total knee arthroplasty. J Arthroplast. 1988;3:185–7.CrossRefGoogle Scholar
  34. 34.
    Lesh ML, Schneider DJ, Gurvinder F, Davis B, Jacobs CR, Pellegrini VD. The consequences of anterior femoral notching in total knee arthroplasty. A biomechanical study. J Bone Joint Surg Am. 2000;82:1096.PubMedGoogle Scholar
  35. 35.
    Faris PM, Ritter MA, Keating EM. Sagittal plane positioning of the femoral component in total knee arthroplasty. J Arthroplast. 1988;3(4):355–8.CrossRefGoogle Scholar
  36. 36.
    Minoda Y, Kobayashi A, Iwaki H, Ohashi H, Takaoka K. TKA sagittal alignment with navigation systems and conventional techniques vary only a few degrees. Clin Orthop Relat Res. 2009;467(4):1000–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Didden K, Luyckx T, Bellemans J, Labey L, Innocenti B, Vandenneucker H. Anteroposterior positioning of the tibial component and its effect on the mechanics of patellofemoral contact. J Bone Joint Surg Br. 2010;92(10):1466–70.PubMedCrossRefGoogle Scholar
  38. 38.
    Coull R, Bankes MJK, Rossouw DJ. Evaluation of tibial component angles in 79 consecutive total knee arthroplasties. Knee. 1999;6:235–7.CrossRefGoogle Scholar
  39. 39.
    Teter KE, Bregman D, Colwell CW. Accuracy of intramedullary versus extramedullary tibial alignment cutting systems in total knee arthroplasty. Clin Orthop Relat Res. 1995;321:106–10.PubMedGoogle Scholar
  40. 40.
    Engh GA, Petersen TL. Comparative experience with intramedullary and extramedullary alignment in total knee arthroplasty. J Arthroplast. 1990;5(1):1–8.CrossRefGoogle Scholar
  41. 41.
    Argenson JN, Parratte S, Flecher X, et al. Unicompartmental knee arthroplasty: technique through a mini-incision. Clin Orthop Relat Res. 2007;464:32–6.PubMedGoogle Scholar
  42. 42.
    Mullaji AB, Sharma A, Marawar S. Unicompartmental knee arthroplasty: functional recovery and radiographic results with a minimally invasive technique. J Arthroplast. 2007;22:7–11.CrossRefGoogle Scholar
  43. 43.
    Hernigou P, Deschamps G. Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am. 2004;86:506–11.PubMedGoogle Scholar
  44. 44.
    Knutson K, Jonsson G, Andersen JL, et al. Deformation and loosening of the tibial component in knee arthroplasty with unicompartmental endoprostheses. Acta Orthop Scand. 1981;53:667–73.Google Scholar
  45. 45.
    Crawford RW, Evans M, Ling RS, et al. Fluid flow around model femoral components of differing surface finishes: in vitro investigations. Acta Orthop Scand. 1999;70:589.PubMedCrossRefGoogle Scholar
  46. 46.
    Ducheyne P, Kagan II A, Lacey JA. Failure of total arthroplasty due to loosening and deformation of the tibial component. J Bone Joint Surg (Am). 1978;60:384.Google Scholar
  47. 47.
    Krause R, Krug W, Miller J. Strength of cement bone interface. Clin Orthop. 1982;163:290.PubMedGoogle Scholar
  48. 48.
    Convery FR, Malcom LL. Prosthetic fixation with controlled pressurized polymerization of polymethylmethacrylate. Proceedings of the 26th Orthopaedic Research Society Meeting, Atlanta; 1980. p. 77.Google Scholar
  49. 49.
    Walker PS, Soudry M, Ewald FC, et al. Control of cement penetration in total knee arthroplasty. Clin Orthop. 1984;185:155.PubMedGoogle Scholar
  50. 50.
    Lutz MJ, Pincus PF, Whitehouse SL, Halliday BR. The effect of cement gun and cement syringe use on the tibial cement mantle in total knee arthroplasty. J Arthroplast. 2009;24(3):461–7.CrossRefGoogle Scholar
  51. 51.
    Banwart JC, McQueen DA, Friis EA, et al. Negative pressure intrusion technique for total knee arthroplasty. J Arthroplast. 2000;15:360.CrossRefGoogle Scholar
  52. 52.
    British Orthopaedic Association. Knee replacement. A guide to good practice. http://www.boa.ac.uk. 1999.
  53. 53.
    Kalairajah Y, Azurza K, Julme C, Molloy S, Drabu KJ. Health outcome measures in the evaluation of total hip arthroplasties—a comparison between the Harris Hip Score and the Oxford Hip Score. J Arthroplast. 2005;20(8):1037–41.CrossRefGoogle Scholar
  54. 54.
    Vyskocil P, Gerber C, Bamert P. Radiolucent lines and component stability in knee arthroplasty. J Bone Joint Surg Br. 1999;81-B:24–6.CrossRefGoogle Scholar
  55. 55.
    Perera AM, Gogi N, Bathla S, Dutta A, Singh BK. Assessment of the tibial cement mantle in total knee replacement. A prospective controlled, comparative study of two cementing techniques. J Bone Joint Surg Br. 2008;90-B(Supp II):320.Google Scholar
  56. 56.
    Freeman MAR, Sudlow RA, Caswell MW, Radcliff. The management of infected total knee replacements. J Bone Joint Surg. 1985;67-B(5):764.Google Scholar
  57. 57.
    Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9–12.PubMedGoogle Scholar
  58. 58.
    Bach CM, Biedermann R, Goebel G, Mayer E, Rachbauer F. Reproducible assessment of radiolucent lines in total knee arthroplasty. Clin Orthop Relat Res. 2005;434:183–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Lombardi AV, Mallory TH, Staab M, Herrington S. Particulate debris presenting as radiographic dense masses following total knee arthroplasty. J Arthroplast. 1998;13(3):351–5.CrossRefGoogle Scholar
  60. 60.
    Nadlacan LM, Freemont AJ, Paul AS. Wear debris-induced pseudotumour in a cemented total knee replacement. Knee. 2000;7(3):183–5.PubMedCrossRefGoogle Scholar
  61. 61.
    Rorabeck CH, Angliss RD, Lewis PL. Fractures of the femur, tibia, and patella after total knee arthroplasty: decision making and principles of management. Instr Course Lect. 1998;47:449–60.PubMedGoogle Scholar
  62. 62.
    Ryd L, Albrektsson BE, Carlsson L, Dansgård F, Herberts P, Lindstrand A, et al. Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses. J Bone Joint Surg Br. 1995;77(3):377–83.PubMedGoogle Scholar
  63. 63.
    Grewal R, Rimmer MG, Freeman MA. Early migration of prostheses related to long-term survivorship. Comparison of tibial components in knee replacement. J Bone Joint Surg Br. 1992;74(2):239–42.PubMedGoogle Scholar
  64. 64.
    Carlsson LV, Albrektsson BEJ, Freeman MAR, Herberts P, Malchau H, Ryd L. A new radiographic method for detection of tibial component migration in total knee arthroplasty. J Arthroplast. 1993;8(2):117–23.CrossRefGoogle Scholar
  65. 65.
    Wolf J. The law of bone remodelling. Berlin Heidelberg New York: Springer. 1986.Google Scholar
  66. 66.
    Mintzer CM, Robertson DD, Rackemann S, Ewald FC, Scott RD, Spector M. Bone loss in the distal anterior femur after total knee arthroplasty. Clin Orthop Relat Res. 1990;260:135–43.PubMedGoogle Scholar
  67. 67.
    Lenthe GH, Waal Malefijt MC, Huiskes R. Stress shielding after total knee replacement may cause bone resorption in the distal femur. J Bone Joint Surg Br. 1997;79-B:117–22.CrossRefGoogle Scholar

Copyright information

© ISS 2011

Authors and Affiliations

  • Nawfal Al-Hadithy
    • 1
  • Madhavan C. Papanna
    • 1
  • Sana Farooq
    • 2
  • Yegappan Kalairajah
    • 1
  1. 1.Trauma and OrthopaedicsLuton and Dunstable HospitalLutonUK
  2. 2.Accident and EmergencyBarnet General HospitalHertsUK

Personalised recommendations