A total knee replacement should provide decades of pain-free movement. However, there are conditions that can affect a knee implant and require additional surgery to correct. Among them, aseptic loosening and failure is the most common. Aseptic refers to situations where infection is not a factor. In aseptic loosening in a total knee replacement, the bond fails between the bone and the implant without the presence of an infection. In this scenario, the body is often attempting to digest the loose particles present. The body also may start to digest the bone, a process formally known as osteolysis. In a worst-case scenario, the bone weakens and breaks.
When a patient initially undergoes knee replacement surgery, the risk of aseptic loosening is relatively low. However, as the implant and the patient ages, the chance of aseptic loosening increases. Such loosening happens more often with the tibial aspect of the knee replacement rather than the femoral.
Wear-and-tear is the primary reason for aseptic failure in any patient, but generally, this happens a long period of time following the initial surgery. If a patient experiences pain, lessened mobility, or starts limping, aseptic loosening may prove the culprit. Fortunately, any abnormalities in bonding are usually visible on X-rays. Contact a dedicated attorney to learn more about what to do to obtain assistance if you have suffered similar pain.
High Viscosity Cement (HVC) and Early Aseptic Failure
Early aseptic failure is uncommon but when it does happen the type of cement used is often a factor.
The October 2015 edition of The Knee Journal reports that high viscosity cement (HVC) contains properties that may make it more susceptible to early failure, although the rate of such failure is low. During knee surgery revision to correct the aseptic failure, surgeons noted that HVC was “non-adherent to the tibial trays at the time of revision surgery.” HVC has also been responsible for cement debris generation, cement micro-fractures and early failure in total hip replacement surgery.
Who is More Prone to Aseptic Loosening?
Some patients are at greater risk and more prone to experiencing aseptic loosening and failure than others. Younger, more active knee replacement patients are more likely to experience bond failure from sheer wear-and-tear. Avoiding activities such as high-impact aerobics, jogging, and other exercises that put exceptional stress on the joint can reduce the risk of aseptic failure.
In addition, obese or exceptionally large individuals may stress the implant. Males have a higher rate of aseptic failure than females. Patients who smoke or take non-steroidal anti-inflammatory drugs (NSAIDs) may also increase their risk of developing aseptic failure. Genetics may also play a role. Finally, a patient who has had multiple knee surgeries has a greater risk of developing aseptic loosening.
When Knee Revision Surgery Becomes an Option
Aseptic failure accounts for approximately 30 percent of patients requiring knee revision surgery, making it the most common cause. Knee revision surgery is more complex than the original knee replacement surgery. It involves removing the patient’s original knee implant, which has grown into the bone. Once that implant has been removed, there is not as much bone left. A bone graft, either from the patient or a donor, may be necessary to support the new knee implant.
Childers, Schlueter & Smith understands the difficulties involved with failed knee replacement and how it can affect your quality of life. Please note, however, that we are no longer pursuing or investigation new knee replacement claims.