Buckling after Total Knee Replacement
Knee replacement surgeries are highly successful surgeries aimed to help relieve knee pain and associated disability. However, some patients may not have optimal results and may complain of wobbling or buckling of the knee after the surgery.
The buckling of the knee after the replacement is instability that may result from preoperative, operative, or postoperative factors. Frequently, instability after total knee replacement requires revision surgery to address the cause of instability and prevent reoccurrence.
Knee replacement surgery consists of replacing the diseased ends of the bones forming the knee joint with metal and plastic prosthetic parts. During the surgery, the surgeon makes bone cuts using templates at specific angles and directions to ensure a balanced artificial knee joint.
Balancing of the knee ensures that there is no excess pressure or tension on the tissues on the front, back, and sides. Additionally, with the balancing of the knee, the deformity is usually corrected, and the body weight is evenly distributed on both sides of the knee joint.
Intraoperative fluoroscopic image showing modular revision knee replacement.
What is Buckling After Total Knee Replacement?
Imagine you’re walking, and suddenly your knee gives out, causing you to stumble or fall. That’s what buckling feels like. Buckling after TKR refers to a sudden and unexpected loss of strength or stability in the knee joint, leading to a feeling of instability or giving way.
Causes of Buckling After Total Knee Replacement:
Several factors can contribute to buckling after TKR. One major cause is weakness or imbalance in the muscles around the knee. During TKR surgery, some muscles and tissues are inevitably disturbed, which can affect their strength and coordination. Additionally, changes in joint mechanics or alignment after surgery may also contribute to instability.
Another significant factor is proprioception, which is the body’s ability to sense its position in space. Proprioception can be impaired following TKR due to changes in joint anatomy and nerve function, making it harder for the brain to accurately perceive the position and movement of the knee.
Furthermore, complications such as infection, implant loosening, or improper surgical technique can also increase the risk of buckling after TKR. These issues compromise the integrity of the joint, leading to instability and potentially buckling episodes.
Impact on Quality of Life
Buckling after TKR can have a profound impact on a person’s quality of life. It can lead to fear of falling, reduced mobility, and decreased participation in daily activities and recreational pursuits. Additionally, repeated buckling episodes may cause further damage to the knee joint and surrounding structures, exacerbating pain and functional limitations.
The instability is an early sign of failure of knee replacement. The patients may often complain of knee pain with wobbling or buckling of the knee joint. The risk of instability is greater in patients with connective tissue and inflammatory diseases such as rheumatoid arthritis or diabetes mellitus, etc.
Patients requiring knee replacement surgery often have a preoperative knock knee or bow leg deformity. Patients with bow leg deformity have excessive laxity of tissues on the outer side of the knee while the tissues on the inner side are tight or contracted. During the surgery, the surgeon tries to lengthen the contracted tissues by releasing them from the inner side of the knee.
Similarly, in patients with a knock knee deformity who may need a joint replacement surgery, the tissues on the outer side of the knee are contracted and tight. In order to correct the deformity, the surgeon works to release the tight tissues on the outer side of the knee. Excessive release of tissues on either the inner or the outer side of the knee during replacement surgery may lead to joint laxity and instability.
Patients that may require revision knee replacement due to any reason such as infection, loosening, implant malposition, implant breakage, etc. are also at an increased risk of instability following revision surgery.
After the primary knee replacement surgery, the tissues around the knee joint may often become thick and fibrous. The thickening of the tissues may often make balancing the knee difficult during revision surgery leading to instability. Knee instability after replacement surgery is usually divided/classified depending upon the direction of instability.
Varus-valgus instability (side to side)
The patients experience instability in the side to side direction which may occur as a result of excessive cutting of the lower end of the thigh bone (femur), or inadequate correction of knock knee/bow-legs deformity during the surgery.
Flexion instability
The front-back instability may occur as a result of over resection of the back surface of the femur condyle, using a small femur implant, or excessive slope of the tibial implant. In the case of cruciate-retaining (CR) knee replacement, anterior-posterior instability may result from insufficiency of the posterior cruciate ligament.
Mid flexion instability
The instability becomes evident in the form of malrotation on bending the knee from 45 degrees to 90 degrees. A number of different implants and surgical factors may contribute towards mid-flexion instability.
Genu recurvatum
In some patients there may be instability in the form of excessive extension of the leg. The leg overshoots the normal straight alignment of the knee and may become fixed in overextension position as a result of contracture of the iliotibial band. The genu recurvatum deformity may be associated with diseases such as rheumatoid arthritis, Charcot disease, and poliomyelitis.
Intraoperative image of knee replacement surgery.
Global instability
The instability in multiple planes after knee replacement surgery is known as global instability. Global instability often results from severe bone loss as a result of multiple surgeries.
Diagnosis
The diagnosis of instability after a knee replacement is made by the physician based on the history of the patient including the type of surgery and any comorbid conditions. An x-ray, CT scan or MRI may be done to look for implant positioning and the surrounding bone. Blood investigations may be done in case an infection is suspected.
Management
The treatment of knee instability after knee replacement depends upon the degree of instability and the type of instability. The management is usually surgical and bracing may be done in a small subset of patients. The revision surgery may utilize special implants to decrease instability such as hinged implants or implants with rotating platforms.
Treatment Options
Treatment for buckling after TKR depends on the underlying cause and severity of symptoms. In many cases, conservative measures such as physical therapy, strengthening exercises, and gait training can help improve muscle strength and coordination, thereby reducing episodes of buckling.
Orthotic devices such as knee braces or custom orthotics may also provide additional support and stability for individuals experiencing buckling after TKR. These devices help offload stress from the knee joint and improve alignment during weight-bearing activities.
In some cases, surgical intervention may be necessary to address persistent instability or correct underlying issues contributing to buckling. This may involve revision TKR surgery to replace or adjust the existing implants, repair damaged soft tissues, or realign the joint to improve stability and function.
Prevention
While it’s not always possible to prevent buckling after TKR entirely, there are steps individuals can take to minimize their risk. This includes following post-operative rehabilitation protocols prescribed by their healthcare team, maintaining a healthy weight to reduce stress on the knee joint, and avoiding high-impact activities that may increase the risk of injury or implant failure.
Conclusion
Buckling after TKR can be a challenging and frustrating complication for patients to navigate. However, with proper diagnosis and treatment, many individuals can experience significant improvement in symptoms and regain confidence in their ability to move and function without fear of instability. By working closely with their healthcare team and adhering to recommended treatment plans, individuals can take proactive steps to manage buckling after TKR and enjoy a better quality of life.
Do you have more questions?
How common is buckling after total knee replacement surgery?
Buckling after total knee replacement surgery can occur in a minority of patients, but the exact prevalence varies depending on factors such as patient characteristics, surgical technique, and post-operative rehabilitation.
Can buckling after total knee replacement be prevented?
While it’s not always possible to prevent buckling entirely, certain measures such as adherence to rehabilitation protocols, maintaining a healthy weight, and avoiding high-impact activities can help minimize the risk.
Are there specific risk factors that increase the likelihood of experiencing buckling after total knee replacement?
Yes, factors such as muscle weakness or imbalance, impaired proprioception, complications like infection or implant loosening, and improper surgical technique can increase the risk of buckling after total knee replacement.
How is buckling diagnosed?
Diagnosis of buckling after total knee replacement involves a comprehensive evaluation by a healthcare professional, which may include physical examination, imaging studies, and diagnostic injections to identify underlying causes of instability.
What are the typical symptoms of buckling after total knee replacement?
Symptoms of buckling after total knee replacement include sudden loss of strength or stability in the knee joint, leading to a feeling of instability or giving way during weight-bearing activities.
Can physical therapy help with buckling after total knee replacement?
Yes, physical therapy is often an integral part of treatment for buckling after total knee replacement. Strengthening exercises and gait training can help improve muscle strength and coordination, thereby reducing episodes of instability.
Are there any specific exercises that can help prevent or manage buckling after total knee replacement?
Yes, exercises focused on strengthening the muscles around the knee, improving balance and proprioception, and optimizing joint mechanics can be beneficial in preventing and managing buckling after total knee replacement.
What role do orthotic devices play in the treatment of buckling after total knee replacement?
Orthotic devices such as knee braces or custom orthotics may provide additional support and stability for individuals experiencing buckling after total knee replacement. These devices help offload stress from the knee joint and improve alignment during weight-bearing activities.
When is surgical intervention recommended for buckling after total knee replacement?
Surgical intervention may be recommended for persistent instability or underlying issues that contribute to buckling after total knee replacement. This may include revision TKR surgery to replace or adjust implants, repair damaged soft tissues, or realign the joint.
How long does it typically take to recover from revision TKR surgery for buckling?
Recovery from revision TKR surgery for buckling can vary depending on the extent of the procedure and individual patient factors. Generally, rehabilitation and recovery may take several months, with gradual improvement in symptoms and function over time.
What are the potential complications of revision TKR surgery for buckling?
Complications of revision TKR surgery for buckling may include infection, implant failure, persistent instability, stiffness, or nerve damage. However, these risks can be minimized with careful surgical planning and post-operative management.
Is there a risk of recurrence of buckling after successful treatment?
While recurrence of buckling after successful treatment is possible, it’s less common with appropriate rehabilitation and adherence to preventive measures. Close follow-up with healthcare providers can help monitor for any signs of recurrence and intervene as needed.
Are there any alternative treatments for buckling after total knee replacement?
In some cases, alternative treatments such as regenerative therapies or adjunctive procedures like nerve blocks may be considered for individuals who are not candidates for or prefer to avoid surgical intervention. However, the effectiveness of these treatments may vary, and consultation with a healthcare provider is recommended.
How can I manage fear of falling after experiencing buckling episodes?
Managing fear of falling after experiencing buckling episodes involves a combination of physical therapy to improve strength and balance, psychological support to address anxiety and apprehension, and environmental modifications to reduce fall risks at home and in the community.
Can buckling after total knee replacement affect my ability to return to work or participate in recreational activities?
Yes, buckling after total knee replacement can impact your ability to perform daily activities, work tasks, and recreational pursuits. However, with appropriate treatment and rehabilitation, many individuals can regain confidence and resume their desired level of activity.
Are there any long-term consequences of experiencing buckling after total knee replacement?
Long-term consequences of experiencing buckling after total knee replacement may include continued instability, joint damage, and reduced quality of life. However, early detection and intervention can help minimize these risks and improve outcomes.
How can I find a healthcare provider experienced in treating buckling after total knee replacement?
Finding a healthcare provider experienced in treating buckling after total knee replacement involves asking for referrals from your primary care physician, researching specialists in orthopedic surgery or sports medicine, and seeking recommendations from other patients who have undergone similar treatment.
Is there ongoing research into better treatments for buckling after total knee replacement?
Yes, ongoing research aims to identify better treatments for buckling after total knee replacement, including advances in surgical techniques, implant design, rehabilitation protocols, and adjunctive therapies. Participating in clinical trials or studies may offer opportunities to access innovative treatments and contribute to scientific knowledge in this field.
Can buckling after total knee replacement affect my overall quality of life?
Yes, buckling after total knee replacement can significantly impact your overall quality of life by limiting mobility, causing pain and discomfort, and affecting your ability to perform daily activities and participate in social or recreational pursuits. However, with appropriate treatment and support, many individuals can experience improvements in symptoms and regain function.
Are there any lifestyle modifications I can make to help manage buckling after total knee replacement?
Yes, lifestyle modifications such as maintaining a healthy weight, avoiding high-impact activities, using assistive devices as needed, and practicing fall prevention strategies can help manage buckling after total knee replacement and reduce the risk of further injury.
Can buckling after total knee replacement be a sign of implant failure?
Yes, buckling after total knee replacement can be a sign of implant failure, particularly if it occurs suddenly or is accompanied by other symptoms such as pain, swelling, or decreased range of motion. Prompt evaluation by a healthcare provider is important to identify and address any underlying issues.
How can I stay active and maintain fitness after experiencing buckling after total knee replacement?
Staying active and maintaining fitness after experiencing buckling after total knee replacement involves working closely with your healthcare team to develop a personalized exercise program that addresses your specific needs and limitations. This may include low-impact activities such as swimming, cycling, or strength training, as well as modifications to accommodate any residual symptoms or functional deficits.
Is there a support group or community for individuals who have experienced buckling after total knee replacement?
Yes, there are support groups and online communities where individuals who have experienced buckling after total knee replacement can connect with others facing similar challenges, share experiences, and provide mutual support and encouragement. These resources can be valuable for coping with the emotional and practical aspects of living with buckling and navigating the healthcare system.
My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.
I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.
My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.
