Advertisement

Global Instability

  • Alfred J. TriaEmail author
  • Marcel A. BasEmail author
  • Stephen Stephan
  • Matthew S. Hepinstall
  • Kevin I. Perry
  • Arlen D. Hanssen
Chapter

Abstract

Instability after total knee arthroplasty (TKA) remains one of the major reasons for revision surgery. The causes relate to both the soft tissues and the implant positioning. TKA is a procedure that is dependent upon balanced flexion and extension gaps, appropriate overall limb alignment, and appropriate positioning of the implants to the underlying bone. At times it may be possible to revise one of the components. However, because the operative procedure is a combination of bone and soft tissue surgery, it is imperative to address all of the problems at the same time, and this often requires complete revision of the implant.

Keywords

Instability Revision Kinematic Alignment Loosening Gaps 

Supplementary material

Video 11.1

Intraoperative demonstration of the global instability prior to surgical correction. Note the laxity with the knee in full extension in the coronal plane and with the knee at 90° of flexion in the sagittal plane (MPG 19222 kb)

References

  1. 1.
    Vince KG. Why knees fail. J Arthroplasty. 2003;8(3 Suppl 1):39–44.CrossRefGoogle Scholar
  2. 2.
    Unitt L, Sambatakakis A, Johnstone D, Briggs TW. Short term outcome in total knee replacement after soft tissue release and balancing. J Bone Joint Surg. 2008;90(2):159–65.CrossRefGoogle Scholar
  3. 3.
    Roche M, Elson L, Anderson C. Dynamic soft tissue balancing in total knee arthroplasty. Orthop Clin North Am. 2014;45(2):157–65.CrossRefPubMedGoogle Scholar
  4. 4.
    Paratte S, Pagnano MW, 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. 2010;92(12):2143–9.CrossRefGoogle Scholar
  5. 5.
    Nedopil AJ, Howell SM, Hull ML. Does malrotation of the tibial and femoral components compromise function in kinematically aligned total knee arthroplasty? Orthop Clin North Am. 2016;47(1):41–50.CrossRefPubMedGoogle Scholar
  6. 6.
    Insall J, Ranawat CS, Scott WN, Walker P. Total condylar knee replacement: preliminary report. Clin Orthop Relat Res. 1976;120:149–54.Google Scholar
  7. 7.
    Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today—has anything changed after 10 years? J Arthroplasty. 2014;29(9):1774–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Parrate S, Pagnano MW. Instability after total knee arthroplasty. J Bone Joint Surg Am. 2008;90(1):184–94.Google Scholar
  9. 9.
    Vince KG, Abdeen A, Sugimori T. The unstable total knee arthroplasty. The J Arthroplasty. 2006;21(4):44–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Chang MJ, Lim H, Lee NR, Moon YN. Diagnosis, causes and treatments of instability following total knee arthroplasty. Knee Surg Relat Res. 2014;26(2):61–7.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Song SJ, Detch RC, Maloney WJ, Goodman SB, Huddleston JI. Causes of instability after total knee arthroplasty. J Arthroplasty. 2014;29(2):360–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Rodriguez-Merchan EC. Instability following total knee arthroplasty. HSS J. 2011;7(3):273–8.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Indelli PF, Giori N, Maloney W. Level of constraint in revision knee arthroplasty. Curr Rev Musculoskelet Med. 2015;8(4):390–7.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Cooper HJ, Hepinstall MS, Scuderi GR, Rodriguez JA. An algorithmic approach to management of symptomatic instability following total knee arthroplasty (abstract). In: Scientific Exhibit SE10. American Academy of Orthopaedic Surgeons Annual Meeting, 24–28 March 2015, Las Vegas, Nevada.Google Scholar
  15. 15.
    Willson SE, Munro ML, Sandwell JC, Ezzet KA, Colwell CW. Isolated tibial polyethylene insert exchange outcomes after total knee arthroplasty. Clin Orthop Relat Res. 2009;468(1):96–101.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Griffin WL, Scott RD, Dalury DF, Mahoney OM, Chiavetta JB, Odum SM. Modular insert exchange in knee arthroplasty for treatment of wear and osteolysis. Clin Orthop Relat Res. 2007;464:132–7.PubMedGoogle Scholar
  17. 17.
    Babis GC, Trousdale RT, Morrey BF. The effectiveness of isolated tibial insert exchange in revision total knee arthroplasty. J Bone Joint Surg Am. 2002;84(1):64–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Brooks DH, Fehring TK, Griffin WL, Mason JC, McCoy TH. Polyethylene exchange only for prosthetic knee instability. Clin Orthop Relat Res. 2002;404:182–8.CrossRefGoogle Scholar
  19. 19.
    Engh GA, Koralewicz LM, Pereles TR. Clinical results of modular polyethylene insert exchange with retention of total knee arthroplasty components. J Bone Joint Surg Am. 2000;82(4):516–23.CrossRefPubMedGoogle Scholar
  20. 20.
    Konrads C, Brieske S, Holder M, Walcher M, Rudert M, Hoberg M. Outcome of isolated polyethylene tibial insert exchange after primary cemented total knee arthroplasty. Int Orthp. 2014;39(6):1093–7.CrossRefGoogle Scholar
  21. 21.
    Jensen CL, Petersen MM, Jensen KE, Therbo M, Schroder HM. Outcome of isolated tibial polyethylene insert exchange after uncemented total knee arthroplasty. Acta Orthop. 2006;77(6):917–20.CrossRefPubMedGoogle Scholar
  22. 22.
    Baker RP, Masri BA, Greidanus NV, Garbuz DS. Outcome after isolated polyethylene tibial insert exchange in revision total knee arthroplasty. J Arthroplasty. 2013;28:1–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Fehring TK, Valdie AL. Knee instability after total knee arthroplasty. Clin Orthop Relat Res. 1994;(299):157–62.Google Scholar
  24. 24.
    Deshmane PP, Rathod PA, Deshmukh AJ, Rodriguez JA, Scuderi GR. Symptomatic flexion instability in posterior stabilized primary total knee arthroplasty. Orthopedics. 2014;37(9):e768–74.CrossRefPubMedGoogle Scholar
  25. 25.
    Firestone TP, Earle RW. Surgical management of symptomatic instability following failed primary total knee replacement. J Bone Joint Surg Am. 2006;88(Suppl 4):80–4.PubMedGoogle Scholar
  26. 26.
    Petrie JR, Haidukewych GJ. Instability in total knee arthroplasty: assessment and solutions. Bone Joint J. 2016;98-B(1 Suppl A):116–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Luttjeboer JS, Bénard MR, Defoort KC, van Hellemondt GG, Wymenga AB. Revision total knee arthroplasty for instability—outcome for different types of instability and implants. J Arthroplasty. 2016;31(12):2672–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Parratte S, Pagnano MW. Instability after total knee arthroplasty. J Bone Joint Surg Am. 2008;90(1):184–94.PubMedGoogle Scholar
  29. 29.
    Vince KG. Why knees fail. J Arthroplasty. 2003;18(3 Suppl 1):39–44.CrossRefPubMedGoogle Scholar
  30. 30.
    Fehring TK, Valadie AL. Knee instability after total knee arthroplasty. Clin Orthop Relat Res. 1994;(299):157–62.Google Scholar
  31. 31.
    Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M. Early failures in total knee arthroplasty. Clin Orthop Relat Res. 2001;392:315–8.CrossRefGoogle Scholar
  32. 32.
    Abdel MP, Pulido L, Severson EP, Hanssen AD. Stepwise surgical correction of instability in flexion after total knee replacement. Bone Joint J. 2014;96-B(12):1644–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Alfred J. Tria
    • 1
    Email author
  • Marcel A. Bas
    • 2
    Email author
  • Stephen Stephan
    • 3
  • Matthew S. Hepinstall
    • 2
  • Kevin I. Perry
    • 4
  • Arlen D. Hanssen
    • 4
  1. 1.Orthopedic Center of New JerseySomersetUSA
  2. 2.Department of Orthopaedic SurgeryLenox Hill HospitalNew YorkUSA
  3. 3.Department of Orthopaedic SurgeryCedars Sinai Medical CenterCAUSA
  4. 4.Department of Orthopedic SurgeryMayo ClinicRochesterUSA

Personalised recommendations