Imaging and Postoperative Evaluation for Total Knee Replacement

Imaging Modalities

Radiographs are the initial and primary imaging modality for evaluating TKR patients, including anteroposterior, lateral, and axial views with weight-bearing when possible 1, 2, 3
Full-length hip-to-ankle weight-bearing views are used for alignment assessment 1
For asymptomatic TKR follow-up, knee radiographs should be obtained 4, 5

Young patients require radiographic evidence of moderate-to-severe osteoarthritis with documented joint damage and must have completed at least one trial of nonoperative therapy including physical therapy, NSAIDs, and/or intraarticular injections without improvement 6
Rehabilitation started on the day of TKA reduces hospital length of stay 7
Strong evidence supports that a supervised exercise program during the first 2 months after TKA improves physical function 7
Continuous passive motion after knee arthroplasty does not improve outcomes 7

Strong evidence supports use of either all-polyethylene or modular tibial components with no difference in outcomes 7
Strong evidence supports no difference in pain or function with or without patellar resurfacing, though patellar resurfacing may decrease cumulative revision surgeries after 5 years 7
Strong evidence supports not using intraoperative navigation in TKA because there is no difference in outcomes or complications 7

The most common failure mechanisms are loosening (39.9%), infection (27.4%), instability (7.5%), periprosthetic fracture (4.7%), and arthrofibrosis (4.5%) 2, 3, 8, 9
Infection is the most common reason for early revision (<2 years after initial TKA) 2, 8
Aseptic loosening is the most common reason for late revision 2, 8
In cases of unexplained pain, reoperation is unwise and frequently associated with suboptimal results 2, 3, 8