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Evidence-based management of instability after primary total knee arthroplasty 03

Conclusion instability after primary total knee arthroplasty: an
evidence-based review. J Orthop Surg Res. 2021;16:729.
Instability constitutes a significant proportion of
early failures in total knee surgery. The 4) Petrie JR, Haidukewych GJ. Instability in total knee
2,3
arthroplasty: assessment and solutions. Bone Joint J.
orthopaedic surgeons face challenges to 2016;98-B(1 Suppl A):116–119.
minimize the incidence of instability, diagnosis, 5) Hofmann S, Seitlinger G, Djahani O, Pietsch M. The

and resolution of instability. 3 painful knee after TKA: a diagnostic algorithm for failure
analysis. Knee Surg Sports Traumatol Arthrosc.
2011;19(9):1442–1452.
The present review article is an updated guide 6) Abdel MP, Pulido L, Severson EP, Hanssen AD. Stepwise
that highlights major or minor surgical errors that surgical correction of instability in flexion after total knee
replacement. Bone Joint J. 2014;96- B(12):1644–1648.
can produce instability and suggests techniques
7) Cottino U, Sculco PK, Sierra RJ, Abdel MP. Instability
used to avoid such occurrence. The authors after total knee arthroplasty. Orthop Clin North Am.
3
emphasized that orthopaedic surgeons should 2016;47(2):311–316.
be well apprised about the design and features of

various total knee implants and the effect of
different design features that may contribute to

instability. Since a robust diagnostic test is not
3
available, promoting awareness about the

clinical presentations of an unstable total knee
replacement, aspects of the history of the

patient’s recovery, and clinical examination of the
knee joint may serve to overcome diagnostic

challenges. 3

Different types of instability present in different

ways, and each type of instability requires a
different surgical solution. 3

Reference

1) Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections
of primary and revision hip and knee arthroplasty in the
United States from 2005 to 2030. J Bone Joint Surg Am.
2007;89:780–785.

2) Le DH, Goodman SB, Maloney WJ, Huddleston JI.
Current modes of failure in TKA: infection, instability, and
stiffness predominate. Clin Orthop Relat Res.
2014;472:2197–2200.

3) Al-Jabri T, Brivio A, Maffulli N, Barrett D. Management of