Case Studies Direct Shift to Stemmed Femoral Component for Total Knee Arthroplasty in Certain Patients

Hackensack University Medical Center Physicians Review Post-TKA Fractures When Severe Deformity or Ligamentous Instability Present

A review of five cases of fracture following TKA led Rothman Orthopaedic Institute surgeons and researchers affiliated with Hackensack Meridian Hackensack University Medical Center to recommend a shift to stemmed femoral component for certain patients with severe deformity or ligamentous instability. Their detailed findings were published in Arthroplasty Today.

The cases presented involved female patients of shorter stature and average age of 74 who underwent a primary TKA with a midlevel constraint articular surface and a primary femoral component without stem extension who all suffered isolated medial femoral condyle insufficiency fractures. Revision TKA was performed in four of the five cases.

All five patients reviewed suffered an isolated medial femoral condyle insufficiency fracture after TKA and highlight the importance for caution when using an MLC with an unstemmed femoral component in older females of shorter stature with both preoperative valgus deformity and flexion contractures. While midlevel constraint prostheses have provided increased varus/valgus and rotational stability for patients with severe deformity or ligamentous instability undergoing total knee arthroplasty (TKA), the study authors recommend considering implanting a stemmed femoral component when using a midlevel constraint articular surface in this patient population, which may help avoid fracture and revision in these particular cases. As a result of this case review, Hackensack University Medical Center orthopedic specialists now routinely consider implanting a stemmed femoral component in this population.

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