Weight-bearing pain and implant migration, progressive radiolucencies, radiolucency more than 2 mm and subsidence on radiographs and CT are generally accepted criteria for knee arthroplasty loosening: An international Delphi consensus study

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-08-10 DOI:10.1002/ksa.12419

George S. Buijs, Arthur J. Kievit, Matthias U. Schafroth, Michael T. Hirschmann, Leendert Blankevoort, International Consensus Panel

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引用次数: 0

Abstract

Purpose

Establishing the diagnosis of loosening in total or unicondylar knee arthroplasty remains a challenge with different clinical and radiological signs evaluated in study designs with high risk of bias, where few or incomplete criteria are formulated for establishing the diagnosis of implant loosening. This study aimed at evaluating the variability between different clinical and radiological criteria and establish a consensus regarding clinical and radiological criteria for the diagnosis of knee arthroplasty loosening.

Methods

Highly specialized knee surgeons focusing on revision arthroplasty were invited to take part in an international panel for a Delphi consensus study. In the first round, the participants were asked to state their most important clinical and radiological criteria for implant loosening. In a second round, the panel's agreement with the collected criteria was rated on a 5-point Likert scale (1–5). High variability was defined by receiving at least one score each indicating complete disagreement and complete agreement. Consensus was established when over 70% of participants rated a criterion as ‘fully agree’ (5) or ‘mostly agree’ (4).

Results

High variability was observed in 56% of clinical criteria and 38% of radiological criteria. A consensus was reached on one clinical (weight-bearing pain [82%]) and four radiological criteria, that is, implant migration, progressive radiolucencies, subsidence and radiolucencies >2 mm on X-ray or computed tomography (CT) (84%–100%).

Conclusion

Amongst specialized knee revision surgeons, there is high variability in clinical and radiological criteria that are seen as important contributing factors to diagnosis of knee implant loosening. A consensus was reached on weight-bearing pain as clinical criterion and on implant migration, progressive radiolucencies, subsidence and radiolucencies of more than 2 mm on X-ray or CT as radiological criteria. The variability rates observed, along with the criteria that reached consensus, offer important insights for the standardization of diagnostic protocols.

Level of evidence

Level V.

Abstract Image

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负重疼痛和假体移位、进行性放射性肿胀、放射性肿胀超过 2 毫米以及放射影像和 CT 显示下沉是膝关节置换术松动的公认标准：国际德尔菲共识研究。

目的：确定全髁或单髁膝关节置换术松动的诊断仍是一项挑战，在偏倚风险较高的研究设计中对不同的临床和放射学征象进行评估，其中很少或没有制定完整的标准来确定植入物松动的诊断。本研究旨在评估不同临床和放射学标准之间的差异，并就膝关节置换术松动诊断的临床和放射学标准达成共识。方法：邀请专注于翻修关节置换术的高度专业膝关节外科医生参加德尔菲共识研究的国际小组。在第一轮讨论中，与会者被要求陈述他们对假体松动最重要的临床和放射学标准。在第二轮讨论中，小组成员对所收集标准的同意程度采用 5 点李克特量表（1-5）进行评分。完全不同意和完全同意的得分至少各占一分，即为差异较大。当超过 70% 的参与者将某项标准评为 "完全同意"（5 分）或 "基本同意"（4 分）时，即为达成共识：56% 的临床标准和 38% 的放射学标准存在较大差异。就一项临床标准（负重疼痛[82%]）和四项放射学标准达成了共识，即假体移位、渐进性放射性肿胀、下沉和 X 射线或计算机断层扫描（CT）上放射性肿胀大于 2 毫米（84%-100%）：结论：在专业膝关节翻修外科医生中，临床和放射学标准差异很大，而这些标准被视为诊断膝关节假体松动的重要因素。临床标准是负重疼痛，放射学标准是 X 光片或 CT 上出现的假体移位、渐进性放射性肿胀、下沉和放射性肿胀超过 2 毫米。观察到的变异率以及达成共识的标准为诊断方案的标准化提供了重要启示：证据等级：V 级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).