Clin Orthop Surg.  2018 Jun;10(2):260-264. 10.4055/cios.2018.10.2.260.

Three Cases of Femoral Stem Failure in Rotating Hinge Revision Total Knee Arthroplasty: Causes and Surgical Considerations

• Sandiford
• Phillips J
• Back DL
• Toms AD

• KMID: 2411754
• DOI: http://doi.org/10.4055/cios.2018.10.2.260

Abstract

Catastrophic failure of stemmed components in arthroplasty is an uncommon but a serious complication. Stem fractures and techniques for addressing these have been described following hip arthroplasty but much less so following total knee arthroplasty (TKA). We review three cases of catastrophic failure of the stem in rotating hinge revision TKA prostheses. We discuss the possible mechanism of failure and review the current literature addressing this topic. Metaphyseal support needs to be optimized in order to minimize load transfer to the stem and to the junction (and the risk of fracture) if a modular component is used. When constrained components are used, radiographs need to be carefully assessed for signs of proximal loosening. Nonmodular stems are also an option in this situation.

Keyword

Fracture; Stem; Arthroplasty; Knee; Revision

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Knee*
Hip
Knee
Prostheses and Implants

Figure

• 

  Fig. 1 Radiographs of case 1 illustrating a fracture of the femoral stem at the stem condyle junction. (A) Anteroposterior view. (B) Lateral view. (C) Post-revision radiograph.

• 

  Fig. 2 Radiographs of case 2 illustrating a fracture of the femoral stem at the junction of the unsupported condylar component and the well-fixed stem. (A) Anteroposterior view. (B) Lateral projection. (C) Reconstruction with a distal femoral replacement.

• 

  Fig. 3 Radiographs of case 3. (A) The femoral stem is fractured at the point where its diameter changes. (B) There are radiolucent lines around the proximal part of the tibial stem but this was asymptomatic and the tibial component was well fixed at the time of surgery. The femoral component was revised with a longer stemmed component.

Reference

1. Akrawi H, Magra M, Shetty A, Ng A. A modified technique to extract fractured femoral stem in revision total hip arthroplasty: a report of two cases. Int J Surg Case Rep. 2014; 5(7):361–364.

2. Bugler KE, Maheshwari R, Ahmed I, Brenkel IJ, Walmsley PJ. Metaphyseal sleeves for revision total knee arthroplasty: good short-term outcomes. J Arthroplasty. 2015; 30(11):1990–1994.

3. Graichen H, Scior W, Strauch M. Direct, cementless, metaphyseal fixation in knee revision arthroplasty with sleevesshort-term results. J Arthroplasty. 2015; 30(12):2256–2259.

4. National Joint Registry. 10th Annual report 2013: national joint registry for England, Wales and Northern Ireland [Internet]. Hemel Hempstead: National Joint Registry;2013. cited 2018 Mar 2. Available from: http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/10th_annual_report/NJR%2010th%20Annual%20Report%202013%20B.pdf.

5. Lim LA, Trousdale RT, Berry DJ, Hanssen AD. Failure of the stem-condyle junction of a modular femoral stem in revision total knee arthroplasty: a report of five cases. J Arthroplasty. 2001; 16(1):128–132.

6. Moreland JR, Marder R, Anspach WE Jr. The window technique for the removal of broken femoral stems in total hip replacement. Clin Orthop Relat Res. 1986; (212):245–249.

7. Morgan-Jones R, Oussedik SI, Graichen H, Haddad FS. Zonal fixation in revision total knee arthroplasty. Bone Joint J. 2015; 97(2):147–149.

8. Mow CS, Wiedel JD. Structural allografting in revision total knee arthroplasty. J Arthroplasty. 1996; 11(3):235–241.

9. Mow CS, Wiedel JD. Noncemented revision total knee arthroplasty. Clin Orthop Relat Res. 1994; (309):110–115.

10. Murray PB, Rand JA, Hanssen AD. Cemented long-stem revision total knee arthroplasty. Clin Orthop Relat Res. 1994; (309):116–123.