Bilateral Fatigue Fracture of the Femoral Components in a Cruciate-retaining Cementless Total Knee Prosthesis

Abstract

This article reports a case of bilateral fatigue fracture of the femoral components in a cruciate-retaining uncemented total knee arthroplasty (TKA). A 75-year-old woman (height, 158 cm; weight, 72 kg; body mass index, 29.2) had undergone one-stage bilateral TKA for osteoarthritis 11 years previously at the author's institution. Surgery was performed using an uncemented Flexible Nichidai Knee. Equal tension of the collateral ligaments and normal mechanical axis were achieved during the primary procedure. The patient was an ardent lover of the game of badminton and had higher activity levels with daily playing. At 8 years postoperatively, she started complaining of mild pain in both knees. The pain gradually increased, and at 11 years postoperatively, she had difficulty walking. Anteroposterior radiographs showed narrowing of the medial joint space, indicating wear of the polyethylene insert. Lateral radiographs showed signs of broken implants in both knees. There were no signs of gross implant loosening or osteolysis. One-stage revision surgery was performed, and the knees were converted to cemented posterior-stabilized TKAs. At revision, the bilateral femoral components were found to be fractured at the junction between the trochlear flange and the medial condyle, anteriorly to the medial peg. The polyethylene insert showed mild wear at the medial middle portion. In the majority of case reports, stress fractures of the femoral component have predominantly affected the medial condyle, following uncemented implantation of fixed-bearing knees. In this case, failure of bone ingrowth in uncemented components, higher body mass index, and a higher athletic activity led to fatigue fracture of the femoral components.

Fracture of the Femoral Component in TKR – A Case Report

“…In the majority of case reports, stress fractures of the femoral component have predominantly affected the medial condyle, following uncemented implantation of fixed-bearing knees. In this case, failure of bone ingrowth in uncemented components, higher body mass index, and a higher athletic activity led to fatigue fracture of the femoral components [9]. We report the case of fracture of the lateral condyle of a cemented TKR.…”

“…Issues with polyethylene fracture and subsequent base plate failure are already documented [1]. Femoral component fracture in total knee replacement (TKR) is a rare complication [2][3][4][5][6][7][8][9][10][11][12][13][14]. The 1990s saw an increased incidence of implant fractures with the three largest series reported with the uncemented Whiteside Ortholoc II knee replacements (Dow Corning Wright, Arlington, TN, USA) [12][13][14].…”

Intra-articular injection of tranexamic acid via a drain plus drain-clamping to reduce blood loss in cementless total knee arthroplasty

“…Controlling perioperative blood loss is especially a major concern with cementless TKA [4-7]. Two recent meta-analyses were performed to evaluate the use of intravenous tranexamic acid (TA) to reduce blood loss and the need for transfusion after total hip arthroplasty and TKA [8,9].…”

Effect of Injecting Tranexamic Acid from a Drain to the Joint and Drain-Clamping to Reduce Blood Loss during Bilateral Cementless Total Knee Arthroplasty

“…The drain-clamping was performed for keeping the TA in the joint. One ampoule of TA (10% Transamin, 10 ml, 1000 mg; Daiichi-Sankyo, Tokyo, Japan) of TA was injected to each knee-a dose found to be acceptable in previous studies [4][5][6][7][8][9][10][11][12]. The drains were removed 48 hours after the operation in both groups.…”

“…Total knee arthroplasty (TKA) is usually associated with marked postoperative blood loss [1][2][3]. Blood loss is expected to be higher after bilateral TKA than after unilateral TKA and for cementless TKA than for cemented TKA [4][5][6][7][8][9][10]. The requirements for allogeneic blood transfusion increase for these patients.…”