Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2017 Nov 7;4(2):148-152.
doi: 10.1016/j.artd.2017.10.002. eCollection 2018 Jun.

Fracture of the insert cone of a polyethylene liner in a failed posterior-stabilized, rotating-platform total knee arthroplasty

Marc R Angerame  1 , Jason M Jennings  1   2 , Douglas A Dennis  1   2   3   4
Affiliations
Case Reports

Fracture of the insert cone of a polyethylene liner in a failed posterior-stabilized, rotating-platform total knee arthroplasty

Marc R Angerame et al. Arthroplast Today. .

Abstract

Failures unique to posterior cruciate-substituting total knee prostheses rarely include polyethylene post fractures but have been described. We report a case involving a fracture of the distal insert cone of a rotating-platform (RP) polyethylene liner in a primary total knee arthroplasty. This case highlights a 67-year-old male presenting with new-onset knee pain and recurrent effusions with osteolysis 11 years following placement of a posterior-stabilized, RP total knee arthroplasty. At the time of revision surgery, the polyethylene insert cone was found to be fractured just below the junction between cone and the body of the insert. Liner exchange, synovectomy, and osteolytic-defect curettage and cement packing were performed. One year following revision surgery, the patient is without pain and has returned to function without limitations. Clinicians must be aware of this possible failure with RP prostheses in the setting of pain with a stable knee, recurrent aseptic effusions, and osteolysis.

Keywords: insert stem; post fracture; posterior-stabilized; revision total knee arthroplasty.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Coronal profile of the posterior-stabilized, rotating-platform polyethylene insert. Black arrow denotes insert cone. White arrow denotes tibial post.
Figure 2
Figure 2
Anteroposterior, lateral, and Merchant radiographs of the right total knee arthroplasty at the 9-year follow-up interval.
Figure 3
Figure 3
Anteroposterior, lateral, and Merchant views of the right total knee arthroplasty 11 years following operation. White arrow denotes osteolytic defect of the medial tibial plateau.
Figure 4
Figure 4
(a) Bird's eye view of broken polyethylene insert cone within a rotating-platform tibial tray. (b) Backside of the retrieved rotating-platform polyethylene tibial insert with delamination and a broken polyethylene insert cone.
Figure 5
Figure 5
(a) Anteroposterior, lateral, and Merchant views of the right revision total knee arthroplasty at the 5-week postoperative visit. (b) Anteroposterior, lateral, and Merchant views of the right revision total knee arthroplasty at the 1-year postoperative visit.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Swanik C.B., Lephart S.M., Rubash H.E. Proprioception, kinesthesia, and balance after total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses. J Bone Joint Surg. 2004;86-A:328. - PubMed
    1. Misra A.N., Hussain M.R.A., Fiddian N.J., Newton G. The role of the posterior cruciate ligament in total knee replacement. J Bone Joint Surg. 2003;85:389. - PubMed
    1. Kleinbart F.A., Bryk E., Evangelista J., Scott W.N., Vigorita V.J. Histologic comparison of posterior cruciate ligaments from arthritic and age-matched knee specimens. J Arthroplasty. 1996;11:726. - PubMed
    1. Conditt M.A., Noble P.C., Bertolusso R., Woody J., Parsley B.S. The PCL significantly affects the functional outcome of total knee arthroplasty. J Arthroplasty. 2004;19:107. - PubMed
    1. Callaghan J.J., Martin C.T., Gao Y. What can be learned from minimum 20-year followup studies of knee arthroplasty? Clin Orthop Relat Res. 2014;473:94. - PMC - PubMed

Publication types

LinkOut - more resources