An uncommon cause of cemented unicompartmental knee arthroplasty failure: fracture of metallic components

Purpose

Despite good overall clinical results, unicompartmental knee replacements (UKR) are not without their problems and failures have been reported. The most common causes of UKR failure are component loosening, poor patient selection, poor surgical technique, polyethylene wear and progression of arthritis in other compartments. The purpose of this study is to present a series of atraumatic fractures of metallic components in a UKR treated in a single orthopaedic centre.

Method

Since 1999, 121 failed unicompartmental knee arthroplasties have been referred to our centre. In six of these, atraumatic breakage of a metal component in the cemented UKR was seen and included in this study. Pre-operative alignment, BMI and implant longevity were documented. The femoral implant failed in 4 patients and the tibial implant in a further 2.

Results

All the femoral implant fractures occurred within 3 years of UKR surgery (mean: 22.2 months, SD: 10.6 months). Tibial implant breakage occurred at a mean of 8.5 years (SD: 2.4 months) following UKR. All patients were treated with conversion to a navigated total knee replacement. A primary total knee arthroplasty was used in all cases with one patient requiring a tibial component incorporating a wedge and stem following breakage of the original UKR tibial implant.

Conclusion

Fracture of the metallic components is a potential cause of failure of unicompartmental knee arthroplasty. In our experience, the incidence of this complication was 4.9 % of all UKR failures. Patients with a BMI greater than 30 and a progressive deterioration in limb alignment were at greater risk.

Level of evidence

IV.