Diagnostic Approaches to Total Knee Arthroplasty Loosening: From Conventional Imaging to Modern Techniques

Osteoarthritis (OA) is a severe and progressive joint disease that usually affects elderly people. The consequence of this disease in its advanced stage is the need for total knee arthroplasty (TKA). Over the years, there has been a constant increase in the number of TKA procedures, with a predicted increase to 1.26 million procedures by 2030. Diagnostics are based on conventional radiography, although advanced techniques such as radiostereometry, SPECT/CT and PET/CT, which enable early detection of micromigration, are gaining increasing recognition. Vibroarthrography (VAG) is a proposed supplement to diagnostics, enabling the assessment of the characteristics of vibrations and friction of joint surfaces, thus supporting the process of early detection of endoprosthesis instability. The combination of conventional and alternative diagnostic methods, including vibroarthrography, may improve the detection of early TKA loosening. This may also result in increased implant durability. The aim of this article is to review the current state of knowledge on the classification and analysis of endoprosthesis loosening mechanisms. In addition, classic and modern methods of detecting and monitoring loosening are discussed, with particular emphasis on vibroarthrography as a potential tool for early diagnosis.