Semin Musculoskelet Radiol 2019; 23(02): e20-e35
DOI: 10.1055/s-0039-1677697
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Update on Imaging of Knee Arthroplasties: Normal Findings and Hardware Complications

Winnie A. Mar
1   Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
,
Isaiah Tan
6   College of Medicine, Chicago, Illinois
,
Albert Song
2   Department of Radiology, Loyola University Stritch School of Medicine, Maywood, Illinois
,
Imran M. Omar
3   Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
,
Mihra S. Taljanovic
4   Department of Radiology, Department of Medical Imaging, The University of Arizona, College of Medicine, Banner University Medical Center, Tucson, Arizona
,
Gregory Scott Stacy
5   Department of Radiology, University of Chicago Medical Center, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

Publication Date:
29 March 2019 (online)

Abstract

Total knee arthroplasty (TKA) is the most common joint replacement performed. This article reviews the normal appearance of TKA including the most common types of arthroplasties as well as complications. Common complications at the present time are infection, aseptic loosening, and instability. Rarer complications such as polyethylene wear, periprosthetic fracture, and soft tissue pathology are also discussed. Although the mainstay of imaging is radiographs, newer techniques in TKA imaging such as computed tomography and magnetic resonance imaging are also reviewed.

 
  • References

  • 1 Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018; 100 (17) 1455-1460
  • 2 Maradit Kremers H, Larson DR, Crowson CS. , et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 2015; 97 (17) 1386-1397
  • 3 Weinstein AM, Rome BN, Reichmann WM. , et al. Estimating the burden of total knee replacement in the United States. J Bone Joint Surg Am 2013; 95 (05) 385-392
  • 4 Taljanovic MS, Jones MD, Hunter TB. , et al. Joint arthroplasties and prostheses. Radiographics 2003; 23 (05) 1295-1314
  • 5 Tateishi H. Indications for total knee arthroplasty and choice of prosthesis. Japan Med Assoc J 2001; 44 (04) 153-158
  • 6 Bercik MJ, Joshi A, Parvizi J. Posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty: a meta-analysis. J Arthroplasty 2013; 28 (03) 439-444
  • 7 Scott RD. The evolving incidence and reasons for re-operation after fixed-bearing PCL retaining total knee arthroplasty. J Bone Joint Surg Br 2012; 94 (11, Suppl A): 134-136
  • 8 Jones LD, Palmer J, Jackson WFM. Unicompartmental knee arthroplasty. Orthop Trauma 2017; 31: 8-15
  • 9 Miller TT. Imaging of knee arthroplasty. Eur J Radiol 2005; 54 (02) 164-177
  • 10 Borus T, Thornhill T. Unicompartmental knee arthroplasty. J Am Acad Orthop Surg 2008; 16 (01) 9-18
  • 11 Hochman MG, Melenevsky YV, Metter DF. , et al; Expert Panel on Musculoskeletal Imaging. ACR Appropriateness Criteria® imaging after total knee arthroplasty. J Am Coll Radiol 2017; 14 (11S): S421-S448
  • 12 Chalmers BP, Sculco PK, Fehring KA, Taunton MJ, Trousdale RT. Fluoroscopically assisted radiographs improve sensitivity of detecting loose tibial implants in revision total knee arthroplasty. J Arthroplasty 2017; 32 (02) 570-574
  • 13 Gupta A, Subhas N, Primak AN, Nittka M, Liu K. Metal artifact reduction: standard and advanced magnetic resonance and computed tomography techniques. Radiol Clin North Am 2015; 53 (03) 531-547
  • 14 Beaman FD, von Herrmann PF, Kransdorf MJ. , et al; Expert Panel on Musculoskeletal Imaging. ACR Appropriateness Criteria® suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). J Am Coll Radiol 2017; 14 (5S): S326-S337
  • 15 Zhou C, Zhao YE, Luo S. , et al. Monoenergetic imaging of dual-energy CT reduces artifacts from implanted metal orthopedic devices in patients with factures. Acad Radiol 2011; 18 (10) 1252-1257
  • 16 Khodarahmi I, Fishman EK, Fritz J. Dedicated CT and MRI techniques for the evaluation of the postoperative knee. Semin Musculoskelet Radiol 2018; 22 (04) 444-456
  • 17 Katsura M, Sato J, Akahane M, Kunimatsu A, Abe O. Current and novel techniques for metal artifact reduction at CT: practical guide for radiologists. Radiographics 2018; 38 (02) 450-461
  • 18 Bradshaw DA, Lam B, Hoffman R, Zicat B. Case report: Total knee arthroplasty polyethylene liner disengagement identified by arthrography. Knee 2014; 21 (06) 1288-1290
  • 19 Fritz J, Lurie B, Potter HG. MR imaging of knee arthroplasty implants. Radiographics 2015; 35 (05) 1483-1501
  • 20 Talbot BS, Weinberg EP. MR imaging with metal-suppression sequences for evaluation of total joint arthroplasty. Radiographics 2016; 36 (01) 209-225
  • 21 Jungmann PM, Agten CA, Pfirrmann CW, Sutter R. Advances in MRI around metal. J Magn Reson Imaging 2017; 46 (04) 972-991
  • 22 Mulcahy H, Chew FS. Current concepts in knee replacement: features and imaging assessment. AJR Am J Roentgenol 2013; 201 (06) W828-W842
  • 23 Bonner TJ, Patterson P, Tye M, Gregg PJ. The effect of the mechanical axis alignment on survival in total knee arthroplasty at 10 years. Orthop Proc 2011; 93-B: 19
  • 24 Parratte 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 Am 2010; 92 (12) 2143-2149
  • 25 Abdel MP, Ollivier M, Parratte S, Trousdale RT, Berry DJ, Pagnano MW. Effect of postoperative mechanical axis alignment on survival and functional outcomes of modern total knee arthroplasties with cement: a concise follow-up at 20 years. J Bone Joint Surg Am 2018; 100 (06) 472-478
  • 26 Lesh ML, Schneider DJ, Deol G, Davis B, Jacobs CR, Pellegrini Jr VD. The consequences of anterior femoral notching in total knee arthroplasty. A biomechanical study. J Bone Joint Surg Am 2000; 82-A (08) 1096-1101
  • 27 Manaster BJ. Total knee arthroplasty: postoperative radiologic findings. AJR Am J Roentgenol 1995; 165 (04) 899-904
  • 28 Nielsen CS, Nebergall A, Huddleston J, Kallemose T, Malchau H, Troelsen A. Medial overhang of the tibial component is associated with higher risk of inferior knee injury and osteoarthritis outcome score pain after knee replacement. J Arthroplasty 2018; 33 (05) 1394-1398
  • 29 Simsek ME, Akkaya M, Gursoy S. , et al. Posterolateral overhang affects patient quality of life after total knee arthroplasty. Arch Orthop Trauma Surg 2018; 138 (03) 409-418
  • 30 Pabinger C, Berghold A, Boehler N, Labek G. Revision rates after knee replacement. Cumulative results from worldwide clinical studies versus joint registers. Osteoarthritis Cartilage 2013; 21 (02) 263-268
  • 31 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
  • 32 Delanois RE, Mistry JB, Gwam CU, Mohamed NS, Choksi US, Mont MA. Current epidemiology of revision total knee arthroplasty in the United States. J Arthroplasty 2017; 32 (09) 2663-2668
  • 33 Lombardi Jr AV, Berend KR, Adams JB. Why knee replacements fail in 2013: patient, surgeon, or implant?. Bone Joint J 2014; 96-B (11, Suppl A): 101-104
  • 34 Kim KT, Lee S, Ko DO, Seo BS, Jung WS, Chang BK. Causes of failure after total knee arthroplasty in osteoarthritis patients 55 years of age or younger. Knee Surg Relat Res 2014; 26 (01) 13-19
  • 35 Narkbunnam R, Chareancholvanich K. Causes of failure in total knee arthroplasty. J Med Assoc Thai 2012; 95 (05) 667-673
  • 36 Brown III EC, Clarke HD, Scuderi GR. The painful total knee arthroplasty: diagnosis and management. Orthopedics 2006; 29 (02) 129-136 ; quiz 137–138
  • 37 Sadoghi P, Liebensteiner M, Agreiter M, Leithner A, Böhler N, Labek G. Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers. J Arthroplasty 2013; 28 (08) 1329-1332
  • 38 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 (09) 1774-1778
  • 39 Pitta M, Esposito CI, Li Z, Lee YY, Wright TM, Padgett DE. Failure after modern total knee arthroplasty: a prospective study of 18,065 knees. J Arthroplasty 2018; 33 (02) 407-414
  • 40 Squire MW, Della Valle CJ, Parvizi J. Preoperative diagnosis of periprosthetic joint infection: role of aspiration. AJR Am J Roentgenol 2011; 196 (04) 875-879
  • 41 McDowell M, Park A, Gerlinger TL. The painful total knee arthroplasty. Orthop Clin North Am 2016; 47 (02) 317-326
  • 42 Parvizi J, Zmistowski B, Berbari EF. , et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011; 469 (11) 2992-2994
  • 43 Bonanzinga T, Zahar A, Dütsch M, Lausmann C, Kendoff D, Gehrke T. How reliable is the alpha-defensin immunoassay test for diagnosing periprosthetic joint infection? A prospective study. Clin Orthop Relat Res 2017; 475 (02) 408-415
  • 44 Gehrke T, Lausmann C, Citak M, Bonanzinga T, Frommelt L, Zahar A. The accuracy of the alpha defensin lateral flow device for diagnosis of periprosthetic joint infection: comparison with a gold standard. J Bone Joint Surg Am 2018; 100 (01) 42-48
  • 45 Gemmel F, Van den Wyngaert H, Love C, Welling MM, Gemmel P, Palestro CJ. Prosthetic joint infections: radionuclide state-of-the-art imaging. Eur J Nucl Med Mol Imaging 2012; 39 (05) 892-909
  • 46 Taljanovic MS, Gimber LH, Omar IM. , et al. Imaging of postoperative infection at the knee joint. Semin Musculoskelet Radiol 2018; 22 (04) 464-480
  • 47 Palestro CJ, Love C, Miller TT. Infection and musculoskeletal conditions: imaging of musculoskeletal infections. Best Pract Res Clin Rheumatol 2006; 20 (06) 1197-1218
  • 48 Plodkowski AJ, Hayter CL, Miller TT, Nguyen JT, Potter HG. Lamellated hyperintense synovitis: potential MR imaging sign of an infected knee arthroplasty. Radiology 2013; 266 (01) 256-260
  • 49 Li AE, Sneag DB, Greditzer IV HG, Johnson CC, Miller TT, Potter HG. Total knee arthroplasty: diagnostic accuracy of patterns of synovitis at MR imaging. Radiology 2016; 281 (02) 499-506
  • 50 Della Valle C, Parvizi J, Bauer TW. , et al; American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis of periprosthetic joint infections of the hip and knee. J Bone Joint Surg Am 2011; 93 (14) 1355-1357
  • 51 Love C, Marwin SE, Palestro CJ. Nuclear medicine and the infected joint replacement. Semin Nucl Med 2009; 39 (01) 66-78
  • 52 Segura AB, Muñoz A, Brulles YR. , et al. What is the role of bone scintigraphy in the diagnosis of infected joint prostheses?. Nucl Med Commun 2004; 25 (05) 527-532
  • 53 Love C, Tomas MB, Marwin SE, Pugliese PV, Palestro CJ. Role of nuclear medicine in diagnosis of the infected joint replacement. Radiographics 2001; 21 (05) 1229-1238
  • 54 Larikka MJ, Ahonen AK, Junila JA, Niemelä O, Hämäläinen MM, Syrjälä HP. Extended combined 99mTc-white blood cell and bone imaging improves the diagnostic accuracy in the detection of hip replacement infections. Eur J Nucl Med 2001; 28 (03) 288-293
  • 55 Glithero PR, Grigoris P, Harding LK, Hesslewood SR, McMinn DJ. White cell scans and infected joint replacements. Failure to detect chronic infection. J Bone Joint Surg Br 1993; 75 (03) 371-374
  • 56 Larikka MJ, Ahonen AK, Junila JA, Niemelä O, Hämäläinen MM, Syrjälä HP. Improved method for detecting knee replacement infections based on extended combined 99mTc-white blood cell/bone imaging. Nucl Med Commun 2001; 22 (10) 1145-1150
  • 57 Palestro CJ, Kim CK, Swyer AJ, Capozzi JD, Solomon RW, Goldsmith SJ. Total-hip arthroplasty: periprosthetic indium-111-labeled leukocyte activity and complementary technetium-99m-sulfur colloid imaging in suspected infection. J Nucl Med 1990; 31 (12) 1950-1955
  • 58 Kwee TC, Basu S, Torigian DA, Zhuang H, Alavi A. FDG PET imaging for diagnosing prosthetic joint infection: discussing the facts, rectifying the unsupported claims and call for evidence-based and scientific approach. Eur J Nucl Med Mol Imaging 2013; 40 (03) 464-466
  • 59 Palestro CJ. Radionuclide imaging of musculoskeletal infection: a review. J Nucl Med 2016; 57 (09) 1406-1412
  • 60 Basu S, Kwee TC, Saboury B. , et al. FDG PET for diagnosing infection in hip and knee prostheses: prospective study in 221 prostheses and subgroup comparison with combined (111)In-labeled leukocyte/(99m)Tc-sulfur colloid bone marrow imaging in 88 prostheses. Clin Nucl Med 2014; 39 (07) 609-615
  • 61 Pill SG, Parvizi J, Tang PH. , et al. Comparison of fluorodeoxyglucose positron emission tomography and (111)indium-white blood cell imaging in the diagnosis of periprosthetic infection of the hip. J Arthroplasty 2006; 21 (06) (Suppl. 02) 91-97
  • 62 Delank KS, Schmidt M, Michael JW, Dietlein M, Schicha H, Eysel P. The implications of 18F-FDG PET for the diagnosis of endoprosthetic loosening and infection in hip and knee arthroplasty: results from a prospective, blinded study. BMC Musculoskelet Disord 2006; 7: 20
  • 63 Palestro CJ, Love C. Decreased sensitivity of (18)F-fluorodeoxyglucose imaging in infection and inflammation. Semin Nucl Med 2012; 42 (04) 261-266
  • 64 Mulcahy H, Chew FS. Current concepts in knee replacement: complications. AJR Am J Roentgenol 2014; 202 (01) W76-86
  • 65 Cherian JJ, Jauregui JJ, Banerjee S, Pierce T, Mont MA. What host factors affect aseptic loosening after THA and TKA?. Clin Orthop Relat Res 2015; 473 (08) 2700-2709
  • 66 Thiele K, Perka C, Matziolis G, Mayr HO, Sostheim M, Hube R. Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery. J Bone Joint Surg Am 2015; 97 (09) 715-720
  • 67 Le DH, Goodman SB, Maloney WJ, Huddleston JI. Current modes of failure in TKA: infection, instability, and stiffness predominate. Clin Orthop Relat Res 2014; 472 (07) 2197-2200
  • 68 Lum ZC, Shieh AK, Dorr LD. Why total knees fail—a modern perspective review. World J Orthop 2018; 9 (04) 60-64
  • 69 Fraser JF, Werner S, Jacofsky DJ. Wear and loosening in total knee arthroplasty: a quick review. J Knee Surg 2015; 28 (02) 139-144
  • 70 Collier MB, Jewett BA, Engh Jr CA. Clinical assessment of tibial polyethylene thickness: comparison of radiographic measurements with as-implanted and as-retrieved thicknesses. J Arthroplasty 2003; 18 (07) 860-866
  • 71 Naudie DD, Ammeen DJ, Engh GA, Rorabeck CH. Wear and osteolysis around total knee arthroplasty. J Am Acad Orthop Surg 2007; 15 (01) 53-64
  • 72 Yashar AA, Adler RS, Grady-Benson JC, Matthews LS, Freiberg AA. An ultrasound method to evaluate polyethylene component wear in total knee replacement arthroplasty. Am J Orthop 1996; 25 (10) 702-704
  • 73 Sofka CM, Adler RS, Laskin R. Sonography of polyethylene liners used in total knee arthroplasty. AJR Am J Roentgenol 2003; 180 (05) 1437-1441
  • 74 Li AE, Johnson CC, Sneag DB. , et al. Frondlike synovitis on MRI and correlation with polyethylene surface damage of total knee arthroplasty. AJR Am J Roentgenol 2017; 209 (04) W231-W237
  • 75 Purdue PE, Koulouvaris P, Potter HG, Nestor BJ, Sculco TP. The cellular and molecular biology of periprosthetic osteolysis. Clin Orthop Relat Res 2007; 454 (454) 251-261
  • 76 Shanbhag AS, Bailey HO, Hwang DS, Cha CW, Eror NG, Rubash HE. Quantitative analysis of ultrahigh molecular weight polyethylene (UHMWPE) wear debris associated with total knee replacements. J Biomed Mater Res 2000; 53 (01) 100-110
  • 77 Kim CW, Seo SS, Kim JH, Lee HJ, Lee CR. Factors affecting the osteolysis around the components after posterior-stabilized total knee replacement arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23 (06) 1863-1869
  • 78 Romesburg JW, Wasserman PL, Schoppe CH. Metallosis and metal-induced synovitis following total knee arthroplasty: review of radiographic and CT findings. J Radiol Case Rep 2010; 4 (09) 7-17
  • 79 Su EP. Instability in total knee replacement: causes and management. Semin Arthroplasty 2015; 26 (04) 246-250
  • 80 Chang MJ, Lim H, Lee NR, Moon YW. Diagnosis, causes and treatments of instability following total knee arthroplasty. Knee Surg Relat Res 2014; 26 (02) 61-67
  • 81 Song SJ, Detch RC, Maloney WJ, Goodman SB, Huddleston III JI. Causes of instability after total knee arthroplasty. J Arthroplasty 2014; 29 (02) 360-364
  • 82 Petursson G, Fenstad AM, Gøthesen Ø. , et al. Computer-assisted compared with conventional total knee replacement: a multicenter parallel-group randomized controlled trial. J Bone Joint Surg Am 2018; 100 (15) 1265-1274
  • 83 Yoshino N, Takai S, Ohtsuki Y, Hirasawa Y. Computed tomography measurement of the surgical and clinical transepicondylar axis of the distal femur in osteoarthritic knees. J Arthroplasty 2001; 16 (04) 493-497
  • 84 Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L. Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 2001; (392) 46-55
  • 85 Murakami AM, Hash TW, Hepinstall MS, Lyman S, Nestor BJ, Potter HG. MRI evaluation of rotational alignment and synovitis in patients with pain after total knee replacement. J Bone Joint Surg Br 2012; 94 (09) 1209-1215
  • 86 Yoo JD, Kim NK. Periprosthetic fractures following total knee arthroplasty. Knee Surg Relat Res 2015; 27 (01) 1-9
  • 87 Rorabeck CH, Taylor JW. Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin North Am 1999; 30 (02) 209-214
  • 88 Felix NA, Stuart MJ, Hanssen AD. Periprosthetic fractures of the tibia associated with total knee arthroplasty. Clin Orthop Relat Res 1997; (345) 113-124
  • 89 Melloni P, Valls R, Veintemillas M. Imaging patellar complications after knee arthroplasty. Eur J Radiol 2008; 65 (03) 478-482
  • 90 Gopinathan P. Patello-femoral clunk syndrome-current concepts. J Orthop 2014; 11 (02) 55-57
  • 91 Heyse TJ, Chong R, Davis J, Haas SB, Figgie MP, Potter HG. MRI diagnosis of patellar clunk syndrome following total knee arthroplasty. HSS J 2012; 8 (02) 92-95
  • 92 Saksena J, Platts AD, Dowd GS. Recurrent haemarthrosis following total knee replacement. Knee 2010; 17 (01) 7-14
  • 93 Ohdera T, Tokunaga M, Hiroshima S, Yoshimoto E, Matsuda S. Recurrent hemarthrosis after knee joint arthroplasty: etiology and treatment. J Arthroplasty 2004; 19 (02) 157-161
  • 94 Cheuy VA, Foran JRH, Paxton RJ, Bade MJ, Zeni JA, Stevens-Lapsley JE. Arthrofibrosis associated with total knee arthroplasty. J Arthroplasty 2017; 32 (08) 2604-2611