Treatment Options for Knee Catching After Total Knee Replacement

Initial Evaluation

The American College of Radiology recommends plain radiographs (X-rays) of the knee as the first step in evaluating patients with post-TKA symptoms like catching to assess component positioning, alignment, and potential complications 2, 1
Clinical assessment should focus on differentiating between common causes of post-TKA symptoms, including component malposition or rotation issues 3 and periprosthetic soft tissue abnormalities 2

For suspected component rotation issues, the American College of Radiology recommends a CT scan without IV contrast as the imaging modality of choice (rated 9/9 for appropriateness) 2, 1
For suspected component rotation issues, an MRI without IV contrast may be considered as an alternative (rated 6/9 for appropriateness) 2
For suspected periprosthetic soft tissue abnormalities, an MRI knee without IV contrast (rated 7/9 for appropriateness) 2 and ultrasound knee (rated 7/9 for appropriateness) 2 are recommended

Physical therapy focusing on quadriceps strengthening is a treatment option for patellar tracking problems 1
Bracing for mild instability is a treatment option for tibial-femoral instability 1
Physical therapy for mild cases is a treatment option for periprosthetic soft tissue abnormalities 1

The American College of Radiology and Praxis Medical Insights recommend referral back to the orthopedic surgeon for further evaluation for patients with persistent catching despite initial management 1
Annual weight-bearing radiographs are recommended for detecting subclinical wear in the prosthesis, which could eventually lead to mechanical symptoms 1