From the Guidelines
The accidental placement of a left femoral component in a right knee during a DePuy Attune knee replacement is a serious surgical error that would likely require revision surgery to correct the implant and prevent potential complications such as poor alignment, abnormal kinematics, instability, and premature failure of the implant. This type of wrong-sided implantation is a "never event" in healthcare, emphasizing the critical need for meticulous pre-operative planning, surgical time-outs, and component verification to prevent such errors. The DePuy Attune knee system, like other modern knee replacement systems, has distinct left and right components anatomically designed to match the specific geometry of each knee, making the use of a left-sided femoral component in a right knee incompatible and potentially harmful 1.
Clinical Implications
- The error could lead to a range of complications, including aseptic loosening, osteolysis, and instability, which are common causes of total knee arthroplasty (TKA) failure, as highlighted in recent studies 1.
- Aseptic loosening, in particular, is a major cause of late-stage TKA failure, often resulting from mechanical stresses, osteolysis secondary to particle debris, or poor bone stock 1.
- The presence of large areas of osteolysis may suggest component loosening and could necessitate revision surgery, underscoring the importance of early detection and intervention 1.
Diagnostic Approaches
- Radiographs are a crucial initial evaluation tool for suspected complications after TKA, including loosening, osteolysis, and instability, although they may not always be sensitive or specific for diagnosing infection 1.
- Advanced imaging techniques, such as CT scans, may be necessary for a more detailed assessment, especially for evaluating the degree of deformity at the knee joint and the position of the load-bearing axis 1.
Prevention and Management
- Prevention of such errors is paramount and can be achieved through rigorous adherence to safety protocols, including pre-operative verification, surgical time-outs, and clear marking of the surgical site.
- If an error is suspected or identified, prompt revision surgery should be considered to correct the implant and mitigate potential long-term consequences, emphasizing the need for vigilance and swift action in the management of TKA complications.
From the Research
Published Case Report Analysis
- There are no research papers directly related to the specific case of accidentally placing a left femoral component in a right knee replacement DePuy Attune.
- However, studies have investigated the causes of failure and revision in total knee arthroplasties, which may provide some insight into the potential consequences of such an error.
- A study published in 2015 2 found that deep infection was the most frequent cause of re-revision after aseptic revision total knee arthroplasty, followed by instability and loose tibial component.
- Another study from 2023 3 compared the outcomes of isolated versus full component revision in total knee arthroplasty for aseptic loosening and found no significant difference in terms of prosthesis failures, complications, and clinical results at 5 years.
- A 2025 study 4 analyzed the implant-related failures and all-cause revision indications for total knee arthroplasty over a 30-year period and found that the adoption of newer TKA designs has not led to clinically important changes in the 10-year survivorship or patient-reported outcome measures.
- A guideline on writing a case report published in 2019 5 may be useful for authors looking to document and share their experiences with similar cases.
- A study from 2019 6 identified several risk factors associated with revision for prosthetic joint infection following knee replacement, including patient, surgical, and health-care system factors, but did not specifically address the issue of incorrect component placement.