From the Guidelines
Accidentally implanting a left femoral component in a right knee during a DePuy Attune knee replacement can lead to severe complications, including aseptic loosening, osteolysis, and instability, which can result in persistent pain, limited range of motion, and difficulty walking, ultimately requiring revision surgery. The mismatched component would create abnormal biomechanics, resulting in improper alignment, instability, and abnormal wear patterns. Patients may experience persistent pain, limited range of motion, and difficulty walking due to the malrotation of the component, which can cause patellar tracking issues, leading to patellar instability or dislocation 1. Over time, the misalignment can accelerate polyethylene wear, potentially causing osteolysis (bone loss) and early implant loosening or failure, as osteolysis is a leading cause of late TKA revision 1. The abnormal loading patterns may also lead to periprosthetic fractures.
The error of implanting a left femoral component in a right knee can be considered a form of mechanical failure, closely related to other forms of mechanical failure such as osteolysis, instability, polyethylene liner wear, and periprosthetic fracture 1. According to Sharkey et al 1, loosening, infection, instability, periprosthetic fracture, and arthrofibrosis are the most common failure mechanisms in TKA revision procedures. Infection was the most common reason for early revision, and aseptic loosening was the most common reason for late revision.
This error typically requires revision surgery to remove the incorrect component and replace it with the proper right femoral component. The revision procedure carries additional risks including infection, blood loss, and further bone loss 1. Early recognition of this error is crucial, as continued use of the mismatched component will likely lead to progressive joint deterioration and worsening symptoms. Surgeons should always verify component sidedness through multiple checks during surgery to prevent this serious error. The patient satisfaction rate for TKA is relatively high, but factors contributing to patient dissatisfaction include unmet expectations, functional limitations, and postoperative complications including pain 1.
Key complications to consider include:
- Aseptic loosening
- Osteolysis
- Instability
- Periprosthetic fractures
- Patellar tracking issues
- Patellar instability or dislocation
- Polyethylene wear
- Infection
- Blood loss
- Further bone loss These complications can be prevented by ensuring proper component sizing and alignment during the initial surgery, and by verifying component sidedness through multiple checks during surgery 1.
From the Research
Possible Complications of Accidentally Putting in a Left Femoral Component in a Right Knee Replacement DePuy Attune
- Misalignment and soft-tissue imbalance in total knee arthroplasty (TKA) can cause discomfort, pain, inadequate motion, and instability that may require revision surgery 2
- Linear femoral component misplacements (proximal, distal, anterior, posterior) and different component rotations in mechanical alignment compared to kinematic alignment can affect balancing throughout the flexion path 2
- Compartmental forces were significantly influenced by 2 mm linear errors in the femoral component placement, with the largest errors mainly increasing the lateral condyle force, occurring for proximal and posterior component errors 2
- There is no direct evidence in the provided studies to specifically address the complications of accidentally putting in a left femoral component in a right knee replacement DePuy Attune, but the studies suggest that misalignment and soft-tissue imbalance can lead to various complications 2
- Other studies focus on pain management and infection prophylaxis after total knee arthroplasty, but do not directly address the specific complication in question 3, 4, 5, 6