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TKA with femoral condyles rolling off tibial component
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TKA with femoral condyles rolling off tibial component - November 18, 2005 11:47:00 AM
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SJBird55
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Joined: May 10, 2004
From: Michigan
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I really don't know how to describe this and it would be so much easier to input a video here... but picture a patient post total knee arthroplasty performing active knee range of motion into flexion. Picture the person seated with his/her legs over the edge of the treatment table and not touching the floor. When the patient moves the knee into about 95 degrees of flexion, the patient complains that the knee is "out of place" and has a good dose of pain. Now grab the tibia 1/2 way between the foot and the knee and gently unload the joint. Visually I saw the tibia move anterior and laterally and with my hands, I felt a shift/vibration. I had the patient lie supine... picture a supine heel slide... again, at about 95 degrees "out of place" and lots of pain. I held his lower extremity as he sat up and swung his leg over the edge of the bed.... same thing seen and felt.
This guy had a TKA revision - supposedly just the tibial component. I'm not sure what was going on - there were no restrictions in motion requested by the surgeon. I can't remember when he had surgery, but I'm guessing 6 weeks ago or so - he had a DVT and then supposedly a big hematoma in his calf. It's almost as though there isn't a stop or anything on that tibial component and the femoral condyles are sliding off and then clunking back in place or something.
Does this situation sound like a failed tibial component from a biomechanical perspective? The patient has an appointment with his surgeon on Monday to assess the situation, so I guess I'll find out what is up or get blamed for the occurrence (that's usually my luck), but I was just curious. Actually, the patient knows me and I've treated him in the past and graduated with his son, so I'm not worried about any suing or anything... just really curious as to what might have been going on.
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Re: TKA with femoral condyles rolling off tibial component - November 18, 2005 12:42:00 PM
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jma
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Joined: August 24, 2000
From: NY
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There may be a failure of the component that was revised. Thankfully, the patient is going back to the surgeon. Did the patient notice this while in the clinic or before coming to the clinic since the surgery? It does not sound like a good scenario. Interested to know after Monday what was discovered in that revised knee.
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Re: TKA with femoral condyles rolling off tibial component - November 18, 2005 2:58:00 PM
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SJBird55
Posts: 2439
Joined: May 10, 2004
From: Michigan
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The incident only happened with me. When I asked him if he had been doing his heel slides at home since surgery, he just gave me that "guy" look. You know, that fake kind of dumbfounded, what are you talking about look? LOL I interpreted his look to mean that he hasn't been doing squat in the area of exercises since surgery.
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Re: TKA with femoral condyles rolling off tibial component - November 18, 2005 4:10:00 PM
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jma
Posts: 2415
Joined: August 24, 2000
From: NY
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In that case, who knows what he was doing with his knee during those "6 weeks" post surgery before he came to you.
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Re: TKA with femoral condyles rolling off tibial component - November 19, 2005 1:52:00 AM
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SJBird55
Posts: 2439
Joined: May 10, 2004
From: Michigan
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I know this guy... the first time it was "out of place" was with me. I know it hurt him quite a bit when the knee got into whatever it was doing - if it had happened prior to the PT appointment, if you think about it - knowing how people are and knowing the body, he would have guarded his flexion movement pattern and stopped flexing before it did whatever it did.
From doing some reading on the components in TKA, did you realize that if the surgeon is off by 2 mm with I think the femoral component that it translates into a 12 degree loss in flexion? 2 mm! I never realized the degree of precision required or the consequences of lack of precision.
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Re: TKA with femoral condyles rolling off tibial component - November 22, 2005 11:19:00 AM
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SJBird55
Posts: 2439
Joined: May 10, 2004
From: Michigan
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Interestingly, the patient reported that his femoral condyles were rolling off the tibial component, but the reason was because prior to surgery he had multiple bleeds in his knee and had been hospitalized multiple times because of the bleeds to have the knee aspirated. The bleeding was occurring at the tibia. I've never really heard of this...
Anyways, the surgeon is a specialist that just performs revisions to total knee arthroplasties (TKA). The original TKA was 6-7 years ago (I treated him after the original procedure and I have no recollection of anything unusual). Anyways, yes, the femur was sliding posteriorly and shifting posteriorly supposedly secondary to posterior capsule laxity secondary to the multiple bleeds within the knee joint. The surgeon did exactly as I had described in my note to him and had the same result and saw/felt the shift just like I did after the femur slid posteriorly. So... this poor guy is going to be in a brace that maintains the knee in full knee extension for 8 weeks. Therapy was still ordered - no knee flexion movements. Focus completely on quadriceps. Rehab will NOT be fun in February... I'm hoping that the capsule is loose enough right now so that when it scars it doesn't scar too tight... uggh...
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Re: TKA with femoral condyles rolling off tibial component - November 22, 2005 12:32:00 PM
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jma
Posts: 2415
Joined: August 24, 2000
From: NY
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Interesting! No, therapy will not be fun when the patient returns. Hopefully, the multiple bleeds will cease by that time as well. I would like to know what the source of the multiple bleeds were. Was there an infection or some sort or other medical issues? It seems that the original TKA lasted about only half its lifetime. At least from what I can remember.
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