From the Guidelines
Crepitance in a knee replacement one year after surgery is most likely caused by aseptic loosening, which is a common cause of total knee arthroplasty (TKA) failure, as found in a 2023 study by the Journal of the American College of Radiology 1. This condition occurs when the implant components begin to detach from the bone, leading to a grinding or cracking sensation. Other possible causes of crepitance include polyethylene wear, patellar issues, and soft tissue problems. Some key points to consider:
- Aseptic loosening is a major cause of late-stage TKA failure, accounting for 39.9% of revision cases, as reported by Sharkey et al 1.
- Osteolysis, or particle disease, is another potential cause of crepitance, resulting from the body's reaction to wear and tear on the implant components 1.
- Imaging studies, such as radiographs, CT scans, and MRI, can help diagnose the underlying cause of crepitance, but may have limitations due to metal artifact or other factors 2.
- Treatment for crepitance depends on the underlying cause and may range from observation and physical therapy to revision surgery. It is essential to consult with an orthopedic surgeon for proper evaluation and treatment to prevent potential complications and ensure the longevity of the knee replacement.
From the Research
Causes of Crepitance in a Knee Replacement
- Crepitance in a knee replacement can be caused by several factors, including implant design, range of motion, and certain radiographic parameters 3.
- Patellofemoral crepitation and clunk (PCC) is a known complication of total knee arthroplasty (TKA) with posterior-stabilized designs, and can be caused by the interaction between the patella and the femoral component 4.
- The development of patellar crepitus is associated with an Outerbridge patellar cartilage Grade 4 and joint line elevation 5.
Risk Factors for Crepitance
- Increased posterior tibial slope is associated with the need for arthroscopic excision in patients with PCC 4.
- Patellar resurfacing is not a significant factor in the development of crepitus, and patients with painful or painless patellar crepitus after primary PS-TKAs without patellar resurfacing can be asymptomatic within 1 year of onset of symptoms without additional surgical treatment 5.
Diagnosis and Treatment of Crepitance
- Arthroscopic débridement is the preferred method of treating PCC in patients whose symptoms require intervention 3.
- Arthroscopic excision of the supra-patellar lesion is an effective treatment option for PCC in symptomatic patients, with high patient satisfaction and low recurrence rates 4.
- Vibration arthrometry can be used as a non-invasive diagnostic procedure for the evaluation of the patellofemoral joint cartilage integrity, and can detect physiological patellofemoral crepitus (PPC) signals that reflect the integrity of articular cartilage 6.