Journal of Orthopaedic Reports (Dec 2023)
Aseptic tibial loosening: Radiographic identification remains a diagnostic dilemma
Abstract
Introduction: Aseptic tibial loosening following total knee arthroplasty (TKA) can be challenging to diagnose radiographically. Surgeons often face the clinical scenario of determining implant fixation in patients that do not have serial radiographs and only subtle radiographic features of loosening. Therefore, the purpose of our study was to determine how accurately attendings and trainees are at identifying aseptic tibial loosening. Methods: Two cohorts of patients were identified for this study. Cohort one consisted of twenty patients with aseptic tibial loosening. Cohort two consisted of twenty patients with well-fixed pain-free total knee replacements at one-year follow-up. Surgeons were then given a clinical scenario that all patients are returning with pain at follow-up. The surgeon then reviewed each patient's radiographs and determined whether the tibial component was loose or well-fixed. Results: Overall, surgeons were significantly more likely to correctly identify well-fixed implants than loose implants (p<0.001). There were no significant differences in the surgeon's vs. trainee's ability to diagnose implant fixation (p = 0.926). However, the percentage of correctly identified loose implants was significantly higher for trainees compared to surgeons (p = 0.023). For surgeons, the proportion of correctly identified well-fixed implants was significantly higher than the proportion of correctly identified loose implants (p<0.001). Conclusion: Aseptic tibial loosening following primary total knee arthroplasty remains a diagnostic dilemma. Surgeons were significantly less likely to identify implant loosening than trainees. Improving diagnostic accuracy in this patient population is critical to avoid delaying surgery in patients with implant loosening and avoiding unnecessary surgery in patients with well-fixed implants.
