Assessment of a failed (Painful?) total joint arthroplasty

Abstract

Total joint arthroplasty (TJA) has provided, to patients with end stage major joint arthritis, reliable painless range of movement and functional recovery which can last for more than 15 years [1]. However, the majority of these artificial joints will eventually fail for various reasons, in a variety of failure patterns [2], and revision surgery becomes necessary. The lifetime of a TJA can be divided into three phases: the initial months during which the implant must become rigidly fixed (early stable phase) and the remainder of the implant's life, during which fixation may either be maintained (late stable phase) or lost (late unstable phase). An early unstable phase may also be seen, although infrequently these days, due mainly to errors of surgical technique. Orthopedic surgeons often face the question of how they can diagnose early loss of interface integrity, material structural failures, and how they can diagnose and treat other painful arthroplasty conditions. It should be realized that certain patterns of TJA failures can remain silent for a long period of time (Fig. 10.1). Regular follow-up examination of even painless and well-functioning TJAs should be organized at dedicated orthopedic centers in order to diagnose problems and failures as early as possible. © 2014 Springer-Verlag London. All rights are reserved.