ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025
Weight-bearing pain and implant migration, progressive radiolucencies, radiolucency more than 2 mm and subsidence on radiographs and CT are generally accepted criteria for knee arthroplasty loosening: An international Delphi consensus study.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- SPECT/CT peak tracer uptake is a strong predictor of aseptic loosening in painful total knee arthroplasty.European journal of nuclear medicine and molecular imaging · 2026Article
- Application of autoantibody markers based on phage display immunoprecipitation sequencing technology in the diagnosis of periprosthetic joint infections.Frontiers in cellular and infection microbiology · 2026Article
- Aseptic revision from one rotating-hinge to another rotating-hinge prosthesis - how good are the results?Archives of orthopaedic and trauma surgery · 2025Article
- A structured framework for standardized 3D leg alignment analysis: An international Delphi consensus study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Weight-based tranexamic acid lowers the risk of postoperative blood loss and transfusion requirements compared with fixed-dose regimen in revision knee arthroplasty: a comparative study.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2025Article
- Weight-bearing pain and implant migration, progressive radiolucencies, radiolucency more than 2 mm and subsidence on radiographs and CT are generally accepted criteria for knee arthroplasty loosening: An international Delphi consensus study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- An evaluation of the diagnostic performance of the triphasic bone scintigraphy in patients suspected of aseptic total knee arthroplasty loosening.Journal of orthopaedics · 2025Article
- Visible fluid motion on manipulation as the new threshold for intraoperatively determined knee arthroplasty component loosening: A Delphi study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Non-invasive quantitative assessment of induced component displacement can safely and accurately diagnose tibial component loosening in patients: A prospective diagnostic study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
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6 authors.
Funding
Abstract
purposeEstablishing the diagnosis of loosening in total or unicondylar knee arthroplasty remains a challenge with different clinical and radiological signs evaluated in study designs with high risk of bias, where few or incomplete criteria are formulated for establishing the diagnosis of implant loosening. This study aimed at evaluating the variability between different clinical and radiological criteria and establish a consensus regarding clinical and radiological criteria for the diagnosis of knee arthroplasty loosening.
methodsHighly specialized knee surgeons focusing on revision arthroplasty were invited to take part in an international panel for a Delphi consensus study. In the first round, the participants were asked to state their most important clinical and radiological criteria for implant loosening. In a second round, the panel's agreement with the collected criteria was rated on a 5-point Likert scale (1-5). High variability was defined by receiving at least one score each indicating complete disagreement and complete agreement. Consensus was established when over 70% of participants rated a criterion as 'fully agree' (5) or 'mostly agree' (4).
resultsHigh variability was observed in 56% of clinical criteria and 38% of radiological criteria. A consensus was reached on one clinical (weight-bearing pain [82%]) and four radiological criteria, that is, implant migration, progressive radiolucencies, subsidence and radiolucencies >2 mm on X-ray or computed tomography (CT) (84%-100%).
conclusionAmongst specialized knee revision surgeons, there is high variability in clinical and radiological criteria that are seen as important contributing factors to diagnosis of knee implant loosening. A consensus was reached on weight-bearing pain as clinical criterion and on implant migration, progressive radiolucencies, subsidence and radiolucencies of more than 2 mm on X-ray or CT as radiological criteria. The variability rates observed, along with the criteria that reached consensus, offer important insights for the standardization of diagnostic protocols. LEVEL OF EVIDENCE: Level V.
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