Prodromes of Failure After Revision Total Knee Arthroplasty

Despite the success of revision total knee arthroplasty (TKA), a percentage of revision TKAs will fail due to a variety of reasons, both septic and aseptic. Identifying the prodromal signs and symptoms that suggest a problem is important to prompt early intervention which may optimize outcomes after revision TKA. The potential value of outcome based follow-up coupled with standing radiographs for identifying symptoms of mechanical failure cannot be overstated. A number of patients whose implants are failing may deny knee symptoms that are reflective of implant failure, and this can be reconciled by obtaining concurrent weightbearing radiographs of the knee. The administration of periodic questionnaires and standing radiographs at intervals of 12–24 months can be an effective method of surveillance after revision TKA, particularly when there are obstacles to direct annual follow-up. New technology has also allowed for additional alternative remote monitoring methods. Wearable sensors and new implants can provide objective patient kinematic data, while patient engagement platforms both guide physical activity and obtain patient specific outcomes. The presence of acute pain or swelling can be indicative of deep infection, and decreased range of motion can signal mechanical failure; these symptoms should not be overlooked. Through the above modalities, physicians are alerted when patients have new symptoms or are not meeting objective kinematic goals, allowing for prompt evaluation of sepsis or mechanical failure.