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TKR: symptoms of a loose implant

Josephine

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Properly functioning implants depend on sound fixation to the bone, either by cementing the implant onto the bone or uncemented fixation where the bone grows into a special surfacing on the implant. Cementing is most common.

Although the majority of implants well fixed at the initial knee replacement surgery remain sound for the lifetime of the device, it is possible for them to loosen over time for various reasons which include micromovement or infection. Aseptic loosening is the most common mode of failure of knee implants.

Micro-movement can occur in the short term if the implants have not been seated securely to begin with or long term if there is osteolysis (bone die back) due to excessive stress from excessive usage like high impact sports (aseptic (non-infected) loosening) or infection. During these situations, the cement>implant or bone>implant fixation fails and loosening occurs.

When this happens the most common symptoms include some or all of the following:
Pain: will be experienced in almost any weight bearing movement including walking, climbing stairs, sitting down/standing up, turning, etc.
Aching:There may also be aching when at rest with sleep disturbance
Stiffness and swelling: knee may lose ROM and/or become swollen
Instability: there can be a sense that the knee may give way, although it may not actually do so it feels like it is threatening to do so

If a knee replacement undergoes aseptic loosening, the only resolution is revision.
If it loosens because of infection, it also needs a revision but under a different protocol
Knee infection: what happens when a knee becomes infected?
Infection: peri-prosthetic infection - also known as late onset infection
Antibiotic infusion for knees revised for multiple infection
Fungal periprosthetic infection
Knee infection - The Evolving Challenge
 

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