Missed Pathology- Is this the cause of unhappy TKR patient?

Presenting Author - Sanjay B Londhe
Introduction and aim: TKR remains one of the most successful surgeries in orthopedics a sizeable number of patients still remain dissatisfied reaching to a level of 30% our aim was to examine the excised the synovium from the suprapatellar region in all osteoarthritic knees and evaluate the histopathological report to know if in a few cases the unrelenting pain and discomfort could be due to some undiagnosed pathology within the joint. Material and methods: we selected 40 consecutive knees at our institution operated from Oct 2014 to Jan 2015 of the total knees 7 patients were operated as single stage bilateral knees supra patellar synovial was thoroughly excised and sent for histopathology patient who were clinically serologically and radiological diagnosed as rheumatoid arthritis or sero negative arthritis were excluded. Result: We found abnormal reports in 8 of our 40 knees (20%) 6 of these were proven to be rheumatoid arthritis whilst 2 of the knees showed chronic villous synovitis. Conclusion: 20% of our patients exhibited result which were totally unexpected this could be one of the many cause in persistently dissatisfied patient after a technically well done TKR so as a routine we advocate all surgeons to send the excised synvoium for histopathology during a routine TKR also a large multicentric study undertaken at various centers would definitely help throw more light on this not so well understood topic and thus help reduce this lot of dissatisfied patient.