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Review Question - QID 5980

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QID 5980 (Type "5980" in App Search)
A 63-year-old woman reports giving way of the knee and pain after undergoing primary total knee arthroplasty (TKA) 1 year ago. Examination reveals that the knee is stable in full extension but has gross anteroposterior instability at 90 degrees of flexion. The patient can fully extend her knee with normal quadriceps strength. Studies for infection are negative. AP and lateral radiographs are shown in Figures 12a and 12b, respectively. What is the appropriate management?
  • A
  • B

Anti-inflammatory drugs

1%

10/1426

Knee brace

2%

22/1426

Physical therapy for quadriceps strengthening

2%

27/1426

Revision to a thicker polyethylene insert

6%

82/1426

Revision to a larger, posterior stabilized implant

89%

1274/1426

  • A
  • B

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The radiographs show posterior flexion instability that is the result of a flexion-extension gap imbalance and posterior cruciate ligament incompetence after a posterior cruciate ligament-retaining TKA. The femur is anteriorly displaced on the tibia, with lift-off of the femoral component from the tibial polyethylene. Revision to a larger femoral component will address the larger flexion gap relative to the extension gap, and a posterior stabilized implant will address the posterior cruciate ligament insufficiency. Pagnano and associates, reporting on a series of painful TKAs previously diagnosed as pain of unknown etiology, showed that the pain was secondary to flexion instability. Pain relief was achieved by revision to a posterior stabilized implant.

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