Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 20, Issue 6, pp 1071–1074 | Cite as

Fracture at the stem–condylar junction of a modular femoral prosthesis in a varus–valgus constrained total knee arthroplasty

  • D. D. NikolopoulosEmail author
  • I. G. Polyzois
  • E. A. Magnissalis
  • P. F. Bernard
  • I. V. Michos
Knee

Abstract

We present a rare case of fracture of the modular femoral component in a varus–valgus constrained total knee arthroplasty (TKA) prosthesis which occurred 2 years after implantation. Both femoral and tibial components underwent a second revision using a constrained hinged TKA. Laboratory analysis revealed insufficient metaphyseal bone stock in association with inadequate cement mantle incorporation which made implant fixation solely reliant on the intramedullary stem construct. It was therefore hypothesized that high repetitive stresses over the junction of the modular component led to the fracture. Level of evidence Case report, Level IV.

Keywords

Fracture Modular femoral component Varus–valgus constrained Total knee arthroplasty 

Notes

Acknowledgments

The authors wish to thank S. Zinelis, Assistant Professor of the Biomaterials Lab, Dental School, University of Athens, for executing the SEM examination and microanalysis of the retrieved specimens under study.

Conflict of interest

None.

IRB approval

Institutional Review Board approval was given prior to the review process.

References

  1. 1.
    Ahn JM, Suh JT (2010) Detection of locking bolt loosening in the stem-condyle junction of a modular femoral stem in revision total knee arthroplasty. J Arthroplasty 25:660 e11–660 e13CrossRefGoogle Scholar
  2. 2.
    Bobyn JD, Tanzer M, Krygier JJ, Dujovne AR, Brooks CE (1994) Concerns with modularity in total hip arthroplasty. Clin Orthop Relat Res 298:27–36PubMedGoogle Scholar
  3. 3.
    Han CD, Han CW, Yang IH (2009) Femoral component fracture due to osteolysis after cemented mobile-bearing total knee arthroplasty. J Arthroplasty 24:3237 e7–3237 e12CrossRefGoogle Scholar
  4. 4.
    Howard JL, Kudera J, Lewallen DG, Hanssen AD (2011) Early results of the use of tantalum femoral cones for revision total knee arthroplasty. J Bone Joint Surg Am 93:478–484PubMedCrossRefGoogle Scholar
  5. 5.
    Huang CH, Yang CY, Cheng CK (1999) Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty. J Arthroplasty 14:375–379PubMedCrossRefGoogle Scholar
  6. 6.
    Issack PS, Cottrell JM, Delgado S, Wright TM, Sculco TP, Su EP (2007) Failure at the taper lock of a modular stemmed femoral implant in revision knee arthroplasty. A report of two cases and a retrieval analysis. J Bone Joint Surg Am 89:2271–2274PubMedCrossRefGoogle Scholar
  7. 7.
    Lim LA, Trousdale RT, Berry DJ, Hanssen AD (2001) Failure of the stem-condyle junction of a modular femoral stem in revision total knee arthroplasty: a report of five cases. J Arthroplasty 16:128–132PubMedCrossRefGoogle Scholar
  8. 8.
    Luring C, Perlick L, Schubert T, Tingart M (2007) A rare cause for knee pain: fracture of the femoral component after TKR. A case report. Knee Surg Sports Traumatol Arthrosc 15:756–757PubMedCrossRefGoogle Scholar
  9. 9.
    Mabry TM, Vessely MB, Schleck CD, Harmsen WS, Berry DJ (2007) Revision total knee arthroplasty with modular cemented stems: long-term follow-up. J Arthroplasty 22(6):100–105PubMedCrossRefGoogle Scholar
  10. 10.
    McPherson EJ, Vince KG (1993) Breakage of a total condylar III knee prosthesis. A case report. J Arthroplasty 8:561–563PubMedCrossRefGoogle Scholar
  11. 11.
    Meneghini RM, Lewallen DG, Hanssen AD (2008) Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg Am 90:78–84PubMedCrossRefGoogle Scholar
  12. 12.
    Michos J, Rallis J, Fassoulas A (2006) Fracture of femoral component in a resurfacing total knee arthroplasty. J Arthroplasty 21:1068–1071PubMedCrossRefGoogle Scholar
  13. 13.
    Nadkarni JB, Carden DG (2005) Acute locking in revision total knee arthroplasty due to disengagement of the locking screw. Knee Surg Sports Traumatol Arthrosc 13:190–192PubMedCrossRefGoogle Scholar
  14. 14.
    Peters CL, Erickson J, Kloepper RG, Mohr RA (2005) Revision total knee arthroplasty with modular components inserted with metaphyseal cement and stems without cement. J Arthroplasty 20:302–308PubMedCrossRefGoogle Scholar
  15. 15.
    Wada M, Imura S, Bo A, Baba H, Miyazaki T (1997) Stress fracture of the femoral component in total knee replacement: a report of 3 cases. Int Orthop 21:54–55PubMedCrossRefGoogle Scholar
  16. 16.
    Westrich GH, Hidaka C, Windsor RE (1997) Disengagement of a locking screw from a modular stem in revision total knee arthroplasty. A Report of Three Cases. J Bone Joint Surg Am 79:254–258PubMedCrossRefGoogle Scholar
  17. 17.
    Whiteside LA, Fosco DR, Brooks JG (1993) Fracture of the femoral component in cementless TKA. Clin Orthop Relat Res 286:71–77PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • D. D. Nikolopoulos
    • 1
    • 3
    Email author
  • I. G. Polyzois
    • 1
  • E. A. Magnissalis
    • 2
  • P. F. Bernard
    • 2
  • I. V. Michos
    • 1
  1. 1.4th Department of Orthopaedic SurgeryAsclepeion Voulas General HospitalAttikiGreece
  2. 2.BioHexagon LtdAttikiGreece
  3. 3.AthensGreece

Personalised recommendations