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Fracture of the femoral adapter bolt and taper adapter in a modern rotating platform knee arthroplasty.

ABSTRACT: A 58-year-old woman presented with onset of pain associated with a popping sound after a twisting motion 4 years after left total knee revision arthroplasty. She had a complex medical history, including a reported bone cement allergy, and presented to the hospital unable to bear weight. Plain radiographs revealed a broken femoral component, with the femoral metaphyseal sleeve separated from the distal articular component. During surgery, it was observed that the femoral adapter bolt and taper adapter had both fractured. Scanning electron microscopy of the fracture surfaces of the components confirmed that the implant had failed in fatigue, presumably due to high cyclic loads. Failure at this junction has not been described previously. In this type of knee design, we recommend supporting the distal articular component either with bone, augmentation, and/or bone cement to reduce the risk for this mode of failure.

SUBMITTER: Baral EC

PROVIDER: S-EPMC5712027 | biostudies-other | 2017 Dec

REPOSITORIES: biostudies-other

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Fracture of the femoral adapter bolt and taper adapter in a modern rotating platform knee arthroplasty.

Baral Elexis C EC McLawhorn Alexander S AS Wright Timothy M TM Su Edwin P EP

Arthroplasty today 20170303 4

A 58-year-old woman presented with onset of pain associated with a popping sound after a twisting motion 4 years after left total knee revision arthroplasty. She had a complex medical history, including a reported bone cement allergy, and presented to the hospital unable to bear weight. Plain radiographs revealed a broken femoral component, with the femoral metaphyseal sleeve separated from the distal articular component. During surgery, it was observed that the femoral adapter bolt and taper ad ...[more]

PMID: 29204486

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Project description:There is debate in the literature whether rotating hinge knee (RHK) or constrained condylar knee (CCK) prostheses lead to better clinical outcomes and survival rates in patients undergoing revision total knee arthroplasty (RTKA). The purpose of this meta-analysis is to compare the survivorship and clinical outcomes of RHK and CCK prostheses. In this meta-analysis, we reviewed studies that evaluated pain and function scores, range of motion (ROM), complications, and survival rates in patients treated with RHK or CCK with short-term (<5 years) or midterm (5-10 years) follow-up. The survivorship was considered as the time to additional surgical intervention such as removal or revision of the components. A total of 12 studies (one randomized study and 11 non-randomized studies) met the inclusion criteria and were analyzed in detail. The proportion of the knees in which short-term (<5 years) survival rates (RHK, 83/95; CCK, 111/148; odds ratio [OR] 0.52; 95% CI, 0.24-1.11; P = 0.09) and midterm (5-10 years) survival rates (RHK, 104/128; CCK, 196/234; OR 1.05; 95% CI, 0.56-1.97; P = 0.88) were evaluated did not differ significantly between RHK and CCK prostheses. In addition, there were no significant differences in ROM (95% CI: -0.40 to 9.93; P = 0.07) and complication rates (95% CI: 0.66 to 2.49; P = 0.46). In contrast, CCK groups reported significantly better pain score (95% CI: 0.50 to 2.73; P = 0.005) and function score (95% CI: 0.01 to 2.00; P = 0.05) than RHK groups. This meta-analysis revealed that 87.4% of RHK and 75.0% of CCK prostheses survive at short-term (<5 years), while 81.3% of RHK and 83.8% of CCK prostheses survive at midterm (5-10 years). The differences in standardized mean pain and function scores we detected were likely to be imperceptible to patients and almost certainly below the minimum clinically important level, despite a significant difference in both groups. Based on the findings of the current meta-analysis, RHK prostheses continue to be an option in complex RTKA with reasonable midterm survivorship.

Project description:Background/objectiveUnicompartmental knee arthroplasty (UKA) is a low-invasive knee surgery that enables early recovery. Stress fracture of the medial tibial plateau (MTP) is a complication of UKA that prolongs treatment once it has occurred. We investigated factors affecting its occurrence.MethodsThe study subjects were 167 patients who underwent fixed-bearing UKA between 2009 and 2016 (45 men and 122 women of mean age 77 years, including 134 with osteoarthritis of the knee and 33 with spontaneous osteonecrosis). We measured bone mineral density, installation angle of the tibial component, and leg alignment in those patients who developed stress fracture within 3 months after UKA.ResultsStress fracture did not occur in 155 patients (N group, 45 men and 110 women) and did occur in 12 (SF group, 12 women). The bone mineral density (BMD) of the proximal femur was significantly lower in the SF group, indicating that bone fragility may have contributed to stress fractures at this site. There was no significant difference in the preoperative tibio-femoral angle (TFA), however, postoperative TFA was larger and the magnitude of the change in the valgus direction (ΔTFA) was smaller in the SF group.DiscussionIn usual UKA for medial compartment, the leg is more extroverted postoperatively than preoperatively, and leaving the knee in the genu varus position, which places a greater load on the tibial component, may raise the risk of stress fracture. Although there was no difference between the two groups in the varus angle of the tibial component, in a scatter plot of postoperative TFA and the installation angle of the tibial component members of the SF group were concentrated in the region of high TFA and low varus angle. Varus of the leg and a low varus angle of the tibial component may thus be factors in the occurrence of stress fracture.ConclusionOur results suggested that low BMD in the affected femur, large postoperative TFA, and a combination of large postoperative TFA and small varus angle of the tibial component may contribute to stress fracture of the MTP following UKA.

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Fracture of the femoral adapter bolt and taper adapter in a modern rotating platform knee arthroplasty.

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Fracture of the femoral adapter bolt and taper adapter in a modern rotating platform knee arthroplasty.

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