INTRODUCTION: Reports of fatigue failure of the femoral component of a total knee arthroplasty (TKA) is scanty in the literature. As a result, there are no clearly defined risk factors to aid us in predicting fatigue failure of an implant. Furthermore, these patients may present with non-specific knee pain, which may or may not be well tolerated, depending on the stability of the implant. We report a case of fatigue failure of a poorly cemented femoral component of a TKA in a 72-year-old female, approximately seven years after the initial surgery CASE REPORT: A 72-year-old female presented to our tertiary level arthroplasty unit with new-onset knee pain approximately seven years after undergoing a TKA at our unit. She reported hearing a crack six months earlier, while standing up from a seated position. She had initially presented to her local clinic, but the pathology was missed. She received revision surgery at our institution and was doing well at early follow-up. DISCUSSION: We reviewed the literature on fatigue failure of femoral components in TKA in an attempt to define risk factors. We also summarised all cases of femoral component fatigue failure in the English literature. CONCLUSION: Although femoral component fatigue failure in TKA is rare, the majority of cases have attributed the failure to poor surgical technique. Despite this, certain implants have been failing more often than others, and proposed mechanisms for this exist. Orthopaedic surgeons need to be aware of which implant designs are prone to failure, as well as how meticulous surgical technique can reduce the chances of fatigue failure. Level of evidence: Level 5 Keywords: femoral component, total knee arthroplasty, fatigue failure, stress fracture
Background: Hip and knee arthroplasty procedures are successful surgical procedures, with total hip arthroplasty being named the operation of the 20th century. With there being an estimated rate globally of periprosthetic joint infection of 1% for hips and 2% for knees, this minimal infection rate represents a large global concern. The successful management of periprosthetic joint infection remains controversial with multiple proposed strategies. Our aim is to present our short-term data for a two-stage revision protocol. Methods: A single centre retrospective review of an existing database starting from January 2013 and including April 2019 was conducted looking at patients having undergone two-stage revision for periprosthetic joint infection. The unit utilised a standard approach to two-stage revisions. Data was collected from the existing database to ascertain short-term success based on the Delphibased international multidisciplinary consensus criteria. Results: A total of 2 125 entries were reviewed from the database comprising 1 912 primary arthroplasty procedures. From all revision cases 19 patients were identified to have undergone a two-stage revision by our unit. Of these patients we managed to collect sufficient data to gauge treatment success in 12 patients. Of these 12 patients with a mean follow-up of 25.6 months, ten reported complete wound healing, pain improvement and no subsequent surgery. One patient demised from septic complications and one required subsequent arthrodesis which controlled the sepsis. Conclusion: Our results showed a high infection eradication rate following our two-staged revision protocol despite frequent delays between first and second stages as a result of resource constraints and limitations.
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