Kim Gale  |  July 5, 2019

Category: Legal News

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woman with failing knee replacementDiscovering that you or a close loved one needs to get revision surgery within a few years of a knee replacement is discouraging.

For most people living in chronic joint pain, a total knee arthroplasty can be life-enhancing by allowing for life with less achiness and more freedom of movement. In an ideal situation, a total knee replacement should last 15-20 years. Due to a number of factors, however, some knee prosthetics become loose and require surgical intervention way too soon.

What is Knee Implant Revision?

Knee implant revision is a second attempt at TKA. This can be a simple procedure or a very complicated one depending upon the reason the prosthetic unit has become loose.

According to the orthopedic specialists at MedStar Union Memorial Hospital, an artificial knee joint can become loose because of a variety of reasons, including patient obesity, involvement in high-impact activities such as running, and wear of the plastic spacer or faux meniscus between the components.

Another problem affecting whether or not a knee implant revision surgery will be needed is the patient’s age when the original TKA is done. The average age of a TKA in the U.S. is 65 years and orthopedic physicians attempt to hold off patients from taking this extreme solution any earlier.

Because younger patients run the risk of wearing out the prosthetic due to a higher activity level, it is generally not advisable to replace a knee joint earlier unless the pain level is such that it interferes with a reasonable quality of life.

Most people over the age of 50 tend to slow down their engagement in high impact sports, whereas before that age, the opposite is true. Nevertheless, if a knee arthroplasty is performed prior to that age, patients are advised, according to Healthline, to engage in lower impact aerobic exercise and strength training such as swimming, walking, weight training, cycling, and elliptical machines.

Scans Reveal Indications of Loosening

If a doctor orders an x-ray or other type of scan, the physician will likely look for interface lucency, which is a darkened area that indicates a space exists where it shouldn’t.

According to Cedars-Sinai, an interface lucency of less than 2 millimeters between the bone and the cement that does not progress over time is most often considered normal if the patient isn’t experiencing any pain or other symptoms of loosening.

Any space wider than 2 millimeters may indicate aseptic loosening (no infection present) or the possibility of an infection. The part most often associated with loosening is the tibial component. As it becomes loose, it might lean or tilt into the tibia.

Other problems associated with loosening that a doctor may diagnose through scans include:

  • Surgical cement crumbling or fracturing;
  • A progression of the widening of the interfaces between the bone cement and the bone or between the bone and the uncemented prosthesis;
  • Unintended movement of the prosthetic parts;
  • “Bead shedding” of the coating used to seal porous prosthetic components.

In knee replacement surgeries that make use of a long-stemmed femoral component, most often used in revision surgeries that need extra stabilization, an x-ray may confirm “windshield wiper” lucency.

The x-ray shows the femoral component, which is a long rod going up the femur. When the long stem of the femoral component becomes so loose that it moves back and forth inside the femur from its stable base, the resulting movement looks like a windshield wiper that has moved back and forth inside the femur bone.

How Does the Use of Bone Cement Contribute to Prosthetic Loosening?

There are two types of knee prosthetics—those that rely upon the use of bone cement to adhere the tibial plate stem into the bone, and those that rely upon biological processes to allow the stem to grow into the bone. In some patients, the use of bone cement has caused problems.

As indicated by the U.S. Library of Medicine, the use of high-viscosity (HV) cement in TKA has led to a few instances of knee implant aseptic loosening—loosening of a prosthetic without an accompanying infection.

Physicians tend to prefer using HV cement in knee replacements because it mixes up quickly and sets quickly, but it has been known to fracture microscopically and shed tiny particles of cement into surrounding tissues. When the body tries to absorb these particles it can also absorb viable bone tissue, allowing for failure of the prosthetic.

Knee implant revision surgery can become very complicated if there has been significant bone loss and the entire prosthetic unit needs to be replaced. Getting a new unit to adhere can be difficult and require extensive X-rays, MRIs, and CT scans to plan prior to the surgery. In other revision surgeries, a surgeon may just have to change out the plastic spacer.

If you or a loved one underwent revision knee replacement surgery or your doctor is recommending revision surgery three years or less after the initial implant and a bone cement was used, you may qualify to file a knee replacement revision surgery lawsuit. See if you qualify by filling out the free form on this page.

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