Surgeons may play role in failure of TKA
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With an increase in both primary and revision knee arthroplasties, one of the causes of failure may have to do with surgeons’ decision-making, a presenter at the Current Concepts of Joint Replacement Spring Meeting noted.
“We all know that young people do worse than old, males do worse than females, comorbidities worse than healthy, but we all know these things and yet we take on these patients,” Robert E. Booth Jr., MD, said in his presentation.
Surgeon factors that may lead to failure can be multifactorial as there is always more than one problem with the knee, according to Booth. With instrumentation and techniques evolving and changing over the years, Booth said the biggest error surgeons make is “presuming that [they are] putting in the natural knee.” He noted the common denominator of failed knees has to do with flexion laxity, which may be due to surgeons relegating flexion as a secondary consideration.
“Flexion should be the independent variable and secure and tight, and extension where there is no latitude should be the dependent variable on flexion,” Booth said. “Soft tissue balancing is critical. On the best knees, they are tight in flexion and lax in extension which, although counterintuitive, is the best way to put them in.”
As surgeons are the ones making these surgical decisions, Booth said they have a hand in causing the knee to fail.
“If you choose [cruciate retaining] CR over [posterior stabilized] PS, if you choose uncemented over cemented, if you do not resurface the patella and somebody else does, those are all choices that have only a few percent difference in outcome, but those outcomes are cumulative,” Booth said.
Although use of robotics may provide an additional level of care, Booth said “neither computers nor robots have long-term data to show that there is any clinical significance.”
“You reduce outliers, but we do not necessarily improve it,” Booth said. “So, if these devices give you a delusion of adequacy and that is helpful, that is great; but the outliers are best reduced by experience and doing more and more joints, not relying on computers.” – by Casey Tingle
Reference:
Booth RE Jr. Paper 16. Presented at: Current Concepts in Joint Replacement Spring Meeting; May 18-20, 2020 (virtual meeting).
Disclosure: Booth reports he receives royalties and consulting fees from Zimmer Biomet.
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Booth RE Jr. Paper 16. Presented at: Current Concepts of Joint Replacement Spring Meeting; May 18-20, 2020 (virtual meeting).
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