Specific complications of arthroplasty
Late complications requiring reoperation may develop after joint replacement with an artificial implant. Classic problems include:
- Joint prosthesis dislocation (dislocation).
- Component loosening (loosening). This can be aseptic (due to natural material wear) or develop against the background of a deep periprosthetic infection.
- Periprosthetic fractures. Damage to the bone tissue around the installed construct.
Management strategy: When these conditions develop, the baseline treatment is revision arthroplasty (revision arthroplasty). The surgery is performed only if the patient's somatic status allows them to withstand major intervention.
Features of small joint replacement
Arthroplasty is used not only for large joints, but also in the treatment of osteoarthritis of the first metatarsophalangeal joint of the foot (hallux rigidus). Total or partial arthroplasty (hemiarthroplasty) provides good pain relief and preserves foot function in the short and medium term.
However, the main complication in this case is the inevitable failure (wear) of the implant over time. Due to the small bone stock and biomechanical features of the foot, subsequent revision surgery becomes an extremely difficult task. For this reason, arthrodesis (joint fusion) is often chosen as an alternative, which provides predictable pain relief without significant functional deficit.
Contractures after total knee arthroplasty
One of the functional complications is the formation of a flexion contracture (limitation of extension in the joint).
- Localization of the problem: The main pathogenetic focus is located in the posterior compartment of the knee joint.
- Pathophysiology: The cause is a technical imbalance during bone cuts made during surgery—the formed extension gap turns out to be smaller than the flexion gap.
- Principles of correction: Restoring full range of motion requires sequential soft tissue and bone releases. The initial stages of surgical release include arthrotomy, removal of all accessible osteophytes, and careful mobilization of the femoral condyles.
Risk reduction: partial arthroplasty
In case of isolated knee joint damage, partial (unicompartmental) knee arthroplasty serves as an alternative to total replacement. This method reliably reduces the rate of severe complications (infectious, thromboembolic, cardiovascular) and accelerates recovery by 2 times.
Indications for partial arthroplasty:
- Full-thickness cartilage wear strictly in one compartment.
- Preserved cartilage thickness and an intact meniscus in the adjacent compartment.
- Functionally competent joint stabilizers.
Contraindications:
- Fixed coronal deformity (more than 15 degrees).
- Fixed contracture (extension restriction >15° and flexion >90°).
- Involvement of other joint compartments.
If revision surgery is required in the future due to partial prosthesis wear, surgeons can usually use standard implants for primary total arthroplasty.
Postoperative monitoring
Instrumental monitoring is mandatory for the timely detection of technical errors in implant placement and the prevention of early biomechanical complications.
Before discharging the patient from the hospital, it is necessary to perform radiography of the joint in two projections. This rule applies to both adults and children and is aimed at a rigorous assessment of the positioning quality of the implanted constructs.
The triad of late joint replacement complications is the "D-L-F" rule: Dislocation, Loosening, Fracture (periprosthetic). All three conditions usually require revision surgery.
Class and exam questions
What is the main problem of first metatarsophalangeal joint replacement?
The inevitable wear of the implant in the future. The resulting failure makes revision foot surgery extremely difficult.
Why might the leg not extend after knee replacement?
Most often, this is associated with flexion contracture due to bone cut imbalance: the extension gap was formed smaller than the flexion gap.
What to do in case of aseptic loosening of joint prosthesis components?
Revision arthroplasty (revision arthroplasty) is indicated, provided that the patient's somatic status allows safe surgery.
How to reduce the risk of systemic complications in single-compartment knee osteoarthritis?
Under strict indications, partial (unicompartmental) arthroplasty is recommended. It reliably reduces the risk of infections, thrombosis, and cardiovascular complications.
What else to study on this topic
- Prevention of contractures: positioning, exercise therapy, and corrective splints
- Complications of osteosynthesis: avascular necrosis and nonunion
- Geriatric hip fracture syndrome and FRAX risk assessment
- Surgical treatment of hallux valgus and risks of deformity recurrence
- Indications for synovectomy and synovcapsulectomy
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