2025 ISAKOS Biennial Congress ePoster
Visible fluid motion on manipulation as the new threshold for intraoperatively-determined knee arthroplasty component loosening – a Delphi study
George Samuel Buijs, MD, Amsterdam NETHERLANDS
Arthur Johan Kievit, MD, Weesp NETHERLANDS
Alex Bastiaan Walinga, MD, Amsterdam, North Holland NETHERLANDS
Matthias U. Schafroth, MD, Nigtevecht, Noord-Holland NETHERLANDS
Michael T. Hirschmann, MD, Prof., Bruderholz SWITZERLAND
Leendert Blankevoort, PhD, Amsterdam NETHERLANDS
Amsterdam University Medical Center, University of Amsterdam, Amsterdam, NETHERLANDS
FDA Status Not Applicable
Summary
In a Deplhi study experts agree that loosening of a knee arthroplasty component is confirmed by the finding of visible fluid motion on manipulation of the component.
ePosters will be available shortly before Congress
Abstract
Background
There is a lack of a clear, uniform definition for intra-operatively assessed component loosening of a knee arthroplasty component, complicating the interpretation and interchangeability of results of diagnostic studies using an intraoperative observation as the reference test. The purpose of this study was to establish a consensus among specialized knee revision surgeons regarding the definition of intraoperatively determined loosening of total or unicondylar knee arthroplasty components.
Methods
Utilizing the Delphi consensus method, an international panel of highly specialized knee revision surgeons was invited to participate in a three-round process. The initiation of the first round involved the exploration of possible criteria for intraoperatively determined loosening with open questions. The second round focused on rating these criteria’s importance on a five-point Likert scale. For the third round, criteria with a reached consensus were summarized in consecutive definitions for intraoperatively determined loosening and proposed to the panel. Consensus was established when over 70% of participants agreed with a definition for intraoperatively determined loosening.
Results
The 34 responding panel members described in total 60 different criteria in the first round of which 34 criteria received consensus in the second round. Summarizing these criteria resulted in four different definitions as minimal requirements for intraoperatively determined loosening. Eighty-eight percent of the panel members agreed on defining a component as loose if there is visible fluid motion at the interface observed during specific movements or when gently applying a direct force.
Conclusion
This study successfully established a consensus using a Delphi method among knee revision surgeons on the definition of intraoperatively determined component loosening. By agreeing on the visibility of fluid motion as new definition, this study provides a standardized reference for future diagnostic research. This definition will enhance the interpretability and interchangeability of future diagnostic studies evaluating knee arthroplasty component loosening.