Abstract
Posterolateral rotatory instability is a relatively uncommon cause of unstable total knee arthroplasty (TKA). In most cases, surgical treatment requires revision TKA into a more constrained design or thicker polyethylene liner. We present a case of a patient with unstable TKA who remained unstable after increasing thickness of the polyethylene liner and undergoing more constrained TKA. After several revision surgeries, the patient was still unstable. Posterolateral corner reconstruction with a fibular-based technique using a tibialis anterior allograft was performed. At 1-year follow-up, the patient was stable and asymptomatic and with excellent function. A soft-tissue procedure only (fibular-based posterolateral corner reconstruction) can be effective at restoring posterolateral rotatory stability in a patient with persistent instability after revision TKA.
Highlights
As per Centers for Disease Control statistics, there were 719,000 knee arthroplasties performed in the United States in 2010 [1]
The methods of addressing instability can be as conservative as using a brace or involve surgical options such as revision to a thicker liner, a more constrained prosthesis, a hinged prosthesis, or, in the most extreme cases, an arthrodesis [6]
Previous studies have shown that patients with ligamentous laxity receiving revision with a constrained design have similar long term functional outcomes and prosthesis survivorship to patients without ligamentous instability receiving posterior stabilized implants [4, 7]
Summary
As per Centers for Disease Control statistics, there were 719,000 knee arthroplasties performed in the United States in 2010 [1]. Comparing patients undergoing revisions with these condylar constrained designs due to varus/valgus instability with patients receiving posterior stabilized revisions without instability, studies have found similar results in terms of long term satisfaction and survivorship of the implant [4]. None of these studies address treatment for patients with suboptimal outcomes beyond further revision. The purpose of this case report was to describe a case of persistent posterolateral instability after several revision TKA surgeries, including revision to a condylar constrained design, satisfactorily corrected with soft-tissue reconstruction alone (fibular-based PLC reconstruction using a tibialis tendon allograft) without further prosthesis revision
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
