Skip to main content
SpringerLink
Log in

How to read a postoperative knee replacement radiograph

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

  1. National Joint Registry for England and Wales. 7th Annual report 2010. http://www.njrcentre.org.uk. 2010.

  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.

    Article  PubMed  Google Scholar 

  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. McBride TJ, Prakash D. How to read a postoperative total hip replacement radiograph. Postgrad Med J. 2010. doi:10.1136/pgmj.2009.095620

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  8. Hui FC, Fitzgerald JR. Hinged total knee arthroplasty. J Bone Joint Surg Am. 1980;62:513–9.

    PubMed  CAS  Google Scholar 

  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. 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. 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.

    Article  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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. 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.

    PubMed  Google Scholar 

  17. National Joint Registry for England and Wales. 7th Annual report 2010. Surgical data to December 2009. http://www.njrcentre.org.uk. 2010.

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  24. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Why are total knee arthroplasties failing today? Clin Orthop. 2002;404:7–13.

    Article  PubMed  Google Scholar 

  25. Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg. 1991;73:709–14.

    CAS  Google Scholar 

  26. Rand JA, Coventry MB. Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop. 1988;232:168–73.

    PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  31. Petersen TL, Engh GA. Radiographic assessment of knee alignment after total knee arthroplasty. J Arthroplast. 1988;3:67–72.

    Article  CAS  Google Scholar 

  32. Maquet P. Biomecanique de la gonarthrose. Acta Orthop Belg. 1972;38(SupplI):S33–54.

    Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  38. Coull R, Bankes MJK, Rossouw DJ. Evaluation of tibial component angles in 79 consecutive total knee arthroplasties. Knee. 1999;6:235–7.

    Article  Google Scholar 

  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.

    PubMed  Google Scholar 

  40. Engh GA, Petersen TL. Comparative experience with intramedullary and extramedullary alignment in total knee arthroplasty. J Arthroplast. 1990;5(1):1–8.

    Article  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  Google Scholar 

  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. 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.

    Article  PubMed  CAS  Google Scholar 

  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.

    CAS  Google Scholar 

  47. Krause R, Krug W, Miller J. Strength of cement bone interface. Clin Orthop. 1982;163:290.

    PubMed  Google Scholar 

  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.

  49. Walker PS, Soudry M, Ewald FC, et al. Control of cement penetration in total knee arthroplasty. Clin Orthop. 1984;185:155.

    PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  51. Banwart JC, McQueen DA, Friis EA, et al. Negative pressure intrusion technique for total knee arthroplasty. J Arthroplast. 2000;15:360.

    Article  CAS  Google Scholar 

  52. British Orthopaedic Association. Knee replacement. A guide to good practice. http://www.boa.ac.uk. 1999.

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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. 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. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9–12.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  60. Nadlacan LM, Freemont AJ, Paul AS. Wear debris-induced pseudotumour in a cemented total knee replacement. Knee. 2000;7(3):183–5.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  65. Wolf J. The law of bone remodelling. Berlin Heidelberg New York: Springer. 1986.

  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.

    PubMed  Google Scholar 

  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.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Trauma and Orthopaedics, Luton and Dunstable Hospital, Lewsey Road, Luton, LU4 0DZ, UK

    Nawfal Al-Hadithy, Madhavan C. Papanna & Yegappan Kalairajah

  2. Accident and Emergency, Barnet General Hospital, Wellhouse Lane, Barnet, Herts, EN5 3DJ, UK

    Sana Farooq

Authors
  1. Nawfal Al-Hadithy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Madhavan C. Papanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sana Farooq
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yegappan Kalairajah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nawfal Al-Hadithy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Al-Hadithy, N., Papanna, M.C., Farooq, S. et al. How to read a postoperative knee replacement radiograph. Skeletal Radiol 41, 493–501 (2012). https://doi.org/10.1007/s00256-011-1297-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-011-1297-x

Keywords

Search

Navigation