Abstract
ABSTRACT 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
Highlights
Reports of fatigue failure of the femoral component of a total knee arthroplasty (TKA) is scanty in the literature
Due to the chronicity and progressive pain, she decided to come to our institution for a second opinion. She initially presented to the emergency department and was referred to our clinic after the diagnosis of a femoral component fracture was made
The first reported case of fatigue failure of the femoral component of a TKA was described by Cook in 1991.2 The majority of the cases reported in the English literature have occurred in the same implant, namely Ortholoc II (Wright Medical, Memphis, TN, USA)
Summary
Reports of fatigue failure of the femoral component of a total knee arthroplasty (TKA) are rare in the literature. She did not experience any early post-operative complications She mobilised well with crutches initially, progressing to full weight-bearing without any walking aids by six weeks. Due to the chronicity and progressive pain, she decided to come to our institution for a second opinion She initially presented to the emergency department and was referred to our clinic after the diagnosis of a femoral component fracture was made. At presentation to our institution she was unable to mobilise without a walking frame due to pain and instability Her anterior knee incision was healed with a mature scar. Tibial and peroneal nerve function, as well as perfusion at the ankle, was intact Her pre-operative radiographs revealed a fractured femoral component with signs. Repeat X-rays revealed no radiological signs of loosening (Figure 4)
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