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Catastrophic Failures of the Tibial Post in a Bicruciate Substituting Total Knee Prosthesis.

ABSTRACT: Failure of the tibial post in a bicruciate substituting total knee prosthesis is a rare but catastrophic complication. The authors report 2 cases of a fracture of the polyethylene tibial post with subsequent episodes of knee subluxation. Prompt recognition and early revision of these complications are associated with a favorable early outcome.

SUBMITTER: Marino D

PROVIDER: S-EPMC8079333 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Catastrophic Failures of the Tibial Post in a Bicruciate Substituting Total Knee Prosthesis.

Marino Dominic D Zelinski Zethariah Z Mesko Daniel D Cochran Jason J

Arthroplasty today 20210415

Failure of the tibial post in a bicruciate substituting total knee prosthesis is a rare but catastrophic complication. The authors report 2 cases of a fracture of the polyethylene tibial post with subsequent episodes of knee subluxation. Prompt recognition and early revision of these complications are associated with a favorable early outcome. ...[more]

PMID: 33937464

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Proximal tibial resorption in a modern total knee prosthesis.

Project description:BackgroundIn an effort to minimize backside polyethylene wear and osteolysis associated with titanium tibial baseplates, many manufacturers have transitioned to cobalt chromium alloys. Recent literature has implicated thicker cobalt chromium designs as a potential source of increased stress shielding and resorption. We report the incidence of proximal tibial bone resorption in a large consecutive series of patients undergoing total knee arthroplasty, with a modern total knee design.MethodsFour hundred thirty-two consecutive primary total knee arthroplasties, performed by 2 fellowship-trained arthroplasty surgeons were identified over a 24-month period. In addition to review of the medical records, analysis of preoperative and postoperative radiographs was performed. Utilizing a novel classification system, the severity of resorption was quantified and correlated with patient and implant characteristics.ResultsAfter exclusions, 339 knees were evaluated in 292 patients. Mean follow-up was 13.2 months (range 6-41). Resorption was present in 119 knees (35.1%). Average time to diagnosis of bone loss was 6.9 months (range 2-32) postoperatively. There was a statistically significant difference between resorption and nonresorption groups with regards to gender and preoperative alignment. Most cases were classified as Grade 1. During the study period, 2 patients required revision for aseptic tibial loosening.ConclusionsOur findings suggest that proximal tibial resorption is common with this particular implant, particularly in men and patients with preoperative varus deformity. Although this typically occurs relatively early in postoperative period and in most cases appears to remodel and stabilize, its ultimate clinical significance and effect on implant survivorship remains unclear.

| S-EPMC5994597 | biostudies-literature

Nontraumatic fracture of the polyethylene tibial post in a bi-cruciate stabilized total knee prosthesis.

Project description:Tibial post fracture in total knee arthroplasty is a rare but disabling complication. The authors report a case of a nontraumatic fracture of the polyethylene tibial post in a patient with a bi-cruciate stabilized Journey total knee arthroplasty system with subsequent episodes of knee subluxation. Early revision is required to resolve this particular problem.

| S-EPMC6728542 | biostudies-literature

Catastrophic tibial baseplate failure of a modern cementless total knee arthroplasty implant.

Project description:Tibial baseplate fracture following primary total knee arthroplasty is a rare complication, particularly with modern implants and surgical techniques. This case details the first known report of mid-range follow-up catastrophic failure of a cementless modular, trabecular metal tibial baseplate. This failure highlights the importance of continued follow-up for novel implants, to include cementless knee arthroplasty designs, particularly if new symptoms arise or periarticular bone loss is identified on radiograph.

| S-EPMC6920728 | biostudies-literature

The utility of bicruciate-retaining total knee arthroplasty.

Project description:BackgroundWe describe the features of modern and historical bicruciate-retaining (BCR) total knee arthroplasty (TKA) implants compared with other TKA implant designs, reviewing kinematics, proprioception, operative technique, and clinical results.MethodsWe performed a review based on PubMed, Embase, CINAHL Plus, and Cochrane databases from January 1990 to April 2016 using combinations of the following keywords: "bicruciate-retaining arthroplasty," "bicruciate-retaining total knee arthroplasty," "bicruciate-retaining TKA," "kinematics," "knee kinematics," and "TKA kinematics."ResultsFour studies have supported the notion that preservation of both cruciate ligaments in TKA preserves more "normal" knee kinematics. BCR implants provide greater proprioceptive performance when compared with posterior cruciate-retaining (CR) TKA implants. However, the operative implantation is more challenging with BCR TKAs, requiring the surgeon to take additional precautions. Overall, there did not seem to be a significant difference in short-term clinical outcomes between the BCR and CR implants.ConclusionsThe utility of BCR TKA is still debatable. The literature has not shown clear indications and guidelines for the value and use of this implant. Although kinematics have been shown to mirror the native knee more closely, the clinical outcomes of BCR vs CR TKAs do not differ significantly. Moreover, additional care must be taken when inserting a BCR implant. The anterior cruciate ligament exploration and preservation is more challenging and certain preparation and precautions must take place. Overall, we have not found that BCR implants are significantly superior to CR implants with regards to short term clinical outcomes despite the BCR TKA having improved kinematics and proprioception.

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Avulsion Fracture of Bicruciate Ligament and Patellar Tendon in Bicruciate-Retaining Total Knee Arthroplasty

Project description:Tibial intercondylar fracture with anterior cruciate ligament avulsion is a unique but rare complication of bicruciate-retaining total knee arthroplasty. Here, we describe an even rarer condition that the tibial intercondylar fracture involved bicruciate ligament and partial patellar tendon avulsion fracture resulting in significant clinical instability in a 70-year-old woman, a combination not yet reported in the literature. Dual-energy computed tomography helped characterize the fracture. During revision surgery, the bicruciate retaining total knee arthroplasty was revised to posterior-stabilized total knee arthroplasty and the patellar tendon was repaired with a suture anchor. She recovered well progressively, and at 6 months, she could walk with the use of an assisted walking device.

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The cyclops lesion after bicruciate-retaining total knee replacement.

Project description:The cyclops lesion is a localized anterior arthrofibrosis most commonly seen following anterior cruciate ligament reconstruction. The lesion forms at the anterior cruciate ligament insertion creating a painful extension block between femoral intercondylar notch and tibial plateau. We present 2 cases (3 knees) in which cyclops lesions appeared atypically following bicruciate-retaining total knee replacement. Two lesions occurred in a single patient following bilateral knee replacement. One lesion occurred in an active sportswoman. All 3 resolved following arthroscopic debridement. We describe the presentation of this unusual complication and suggest keys to its diagnosis, treatment, and prevention.

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Tibial Post Refracture in Posterior-Stabilized Total Knee Arthroplasty Following Isolated Tibial Insert Exchange.

Project description:BackgroundWe report 4 cases with a tibial post refracture following isolated tibial insert exchange in posterior-stabilized total knee arthroplasty at a single center.MethodsIn our institution, 27 cases (26 patients) underwent reoperation due to tibial post fracture in posterior-stabilized total knee arthroplasty between July 2008 and November 2020. Of these 27 cases, 4 (4 patients) tibial post refractures occurred at a mean follow-up period of 9.1 years.ResultsAll 4 cases of tibial post refracture occurred in a group of 21 cases with isolated tibial insert exchange. There was no tibial post refracture in patients with a tibial revision surgery. The incidence of this complication following isolated tibial insert exchange was 19.0%. The mean elapsed time from tibial insert exchange to the diagnosis of a post refracture was 2.5 years (range: 1.1-6.6 years).ConclusionsIsolated exchange of a tibial insert with excessive thickness as a treatment for tibial post fracture is associated with a high probability of tibial post refracture. The treatment method should be selected after a thorough analysis according to the cause of fracture.Level of evidenceIV.

| S-EPMC9807858 | biostudies-literature

Failure of the Femoral and Tibial Components Following Anterior Cruciate Ligament Injury After Robotic-Assisted Bicruciate-Retaining Total Knee Arthroplasty.

Project description:We report a case of failure of the femoral and tibial components due to anterior cruciate ligament (ACL) injury after robotic-assisted bicruciate-retaining total knee arthroplasty. A 70-year-old woman with osteoarthritis underwent robotic-assisted bicruciate-retaining total knee arthroplasty. At 8 months after surgery, persistent knee pain and swelling of the knee joint were noted after fall in knee. We diagnosed a failure between the femoral and tibial components following an ACL injury. Proximal ACL injury and spin out of ultra-high molecular weight polyethylene were confirmed. We selected a constrained condylar knee prosthesis due to large bone attribution after femoral and tibial component removal. Postoperative three-dimensional computed tomography images suggested that excessive internal rotational alignment of the tibial component caused stress on the ACL.

| S-EPMC11827018 | biostudies-literature

Catastrophic Failure of the Tibial Component After Total Knee Arthroplasty: Fracture and Dissociation Between the Baseplate and Stem.

Project description:Fracture of the tibial component can be a devastating complication after primary total knee arthroplasty. While fractures of the tibial baseplate have been reported, failure at the junction between the baseplate and stem has not been well-described. We present a 49-year-old male who developed progressively worsening left knee pain and an effusion 7-8 years after an index total knee arthroplasty. Radiographs revealed component subsidence and subtle asymmetry between the baseplate and stem. At the time of revision, the tibial component was found to be fractured at the junction of the baseplate and stem, with complete dissociation between the two pieces. Clinicians should maintain a high index of suspicion for catastrophic failure, as this rare phenomenon can be subtle on radiographs and requires close monitoring for signs of component subsidence.

| S-EPMC8938886 | biostudies-literature

Flexion contracture due to cyclops lesion after bicruciate-retaining total knee arthroplasty.

Project description:Flexion contracture may develop after total knee arthroplasty (TKA) and is usually associated with soft tissue contracture in the posterior compartment or hamstrings. A cyclops lesion is a soft tissue mass which can form in the anterior compartment usually after anterior cruciate ligament reconstruction and has been observed after bicruciate-retaining TKA. We have treated a patient who developed progressive loss of full extension from 0° to 20° after bicruciate-retaining TKA. A large fibrous tissue mass (cyclops lesion) was identified in the anterior compartment during arthrotomy 1 year after TKA. Excision of the mass resulted in complete resolution of the flexion contracture.

| S-EPMC6920727 | biostudies-literature

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