Clin Orthop Surg.  2009 Jun;1(2):118-121. 10.4055/cios.2009.1.2.118.

Fracture of a Polyethylene Tibial Post in a Scorpio Posterior-Stabilized Knee Prosthesis

• Lim HC
• Bae JH
• Hwang JH
• Kim SJ
• Yoon JY

• KMID: 1122643
• DOI: http://doi.org/10.4055/cios.2009.1.2.118

Abstract

We report the case of a polyethylene tibial post fracture in a 72-year-old woman 14 months after a Scorpio posterior-stabilized (PS) total knee arthroplasty. The polyethylene wear was found around the fracture site of the post, especially over the anterior aspect of the post base. The failure mechanism of the post fracture in the present case was anterior impingement with excessive wear over the base of the anterior aspect of the tibial post, which became a stress-riser of post and cam articulation. This is the first report of a polyethylene tibial post fracture of a Scorpio PS prosthesis.

Keyword

Total knee arthroplasty; Posterior-stabilized; Anterior impingement; Polyethylene wear; Post fracture

MeSH Terms

Aged
*Arthroplasty, Replacement, Knee
Female
Humans
Knee Joint/radiography
Knee Prosthesis/*adverse effects
Osteoarthritis, Knee/surgery
*Polyethylenes
*Prosthesis Failure
Reoperation

Figure

• 

  Fig. 1 Radiographs taken in the emergency department 14 months after total knee arthroplasty following slipping and falling. (A) Lateral radiograph showing genu recurvatum, (B) 45° Sky line view showing vertical fracture of the left patella.

• 

  Fig. 2 Coronal fast-spin-echo magnetic resonance image of the left knee in a patient following a slip and fall revealed a loose body in the suprapatellar pouch of the knee consistent in shape with the tip of the tibial polyethylene post.

• 

  Fig. 3 Intraoperative photograph showing a fracture of the polyethylene tibial post at its base.

• 

  Fig. 4 A photograph of the retrieved insert showing fracture of the poly-ethylene tibial post at its base.

Reference

1. Kelly MA, Clarke HD. Long-term results of posterior cruciate-substituting total knee arthroplasty. Clin Orthop Relat Res. 2002. (404):51–57.

2. Thadani PJ, Vince KG, Ortaaslan SG, Blackburn DC, Cudiamat CV. ten- to 12-year followup of the Insall-Burstein I total knee prosthesis. Clin Orthop Relat Res. 2000. (380):17–29.

3. Callaghan JJ, O'Rourke MR, Goetz DD, Schmalzried TP, Campbell PA, Johnston RC. Tibial post impingement in posterior-stabilized total knee arthroplasty. Clin Orthop Relat Res. 2002. (404):83–88.

4. Banks SA, Harman MK, Hodge WA. Mechanism of anterior impingement damage in total knee arthroplasty. J Bone Joint Surg Am. 2002. 84:Suppl 2. 37–42.

5. Mestha P, Shenava Y, D'Arcy JC. Fracture of the polyethylene tibial post in posterior stabilized (Insall Burstein II) total knee arthroplasty. J Arthroplasty. 2000. 15(6):814–815.

6. Clarke HD, Math KR, Scuderi GR. Polyethylene post failure in posterior stabilized total knee arthroplasty. J Arthroplasty. 2004. 19(5):652–657.

7. Chiu YS, Chen WM, Huang CK, Chiang CC, Chen TH. Fracture of the polyethylene tibial post in a NexGen posterior-stabilized knee prosthesis. J Arthroplasty. 2004. 19(8):1045–1049.

8. Li G, Papannagari R, Most E, et al. Anterior tibial post impingement in a posterior stabilized total knee arthroplasty. J Orthop Res. 2005. 23(3):536–541.

9. Babis GC, Trousdale RT, Morrey BF. The effectiveness of isolated tibial insert exchange in revision total knee arthroplasty. J Bone Joint Surg Am. 2002. 84(1):64–68.

10. Engh GA, Koralewicz LM, Pereles TR. Clinical results of modular polyethylene insert exchange with retention of total knee arthroplasty components. J Bone Joint Surg Am. 2000. 82(4):516–523.