Fracture of the Tibial Baseplate 16 Years after Miller-Galante II Total Knee Arthroplasty

Abstract

We report a rare case of tibial baseplate fracture of Miller-Galante II (MG II) prosthesis. We examine the factors that may cause such late fracture and review the literature on radiographic analysis and retrieval studies. A 76-year-old woman, who had undergone bilateral MG II total knee arthroplasty due to rheumatoid arthritis 16 years earlier, presented to our department with a 3-month history of left knee pain. Plain radiographs revealed severe distortion of the medial tibial component. During revision knee arthroplasty, we observed severe metallosis in the knee joint, polyethylene insert deformation, and posteromedial coronal baseplate fracture. After removal of the fractured tray, a bone deficit due to osteolysis was noted. The revision prosthesis (LCCK, Zimmer-Biomet) was implanted uneventfully. Four months after revision surgery, the patient was ambulating and had no complications. The implants on the right side had survived without complications for 17 years. We speculate that the primary causative factor of the fatigue fracture of the base plate due to loss of bony support most likely secondary to osteolysis was varus malalignment at primary implantation. This case highlights the importance of paying close attention to the correct alignment of each component at primary implantation.

Catastrophic tibial baseplate failure of a modern cementless total knee arthroplasty implant

“…Proximal tibial osteolysis secondary to polyethylene wear is the most commonly cited cause for this evolving boney structural deficiency [1]. With the development of focal proximal tibial loss, cantilever bending of the tibial baseplate occurs at the junction between supported and unsupported bone, which eventually leads to fatigue failure of the implant in the cases of fracture [2].…”

“…Fracture of the tibial baseplate is a rare and catastrophic complication of total knee arthroplasty (TKA) that often portends a challenging revision surgery. Previous reports have detailed this mechanism of failure in both cemented and cementless tibial baseplates from multiple different manufacturers [[1], [2], [3]]. However, with improvements in implant design and metallurgy, and the advent of highly cross-linked ultra-high molecular weight polyethylene (UHMWPE) inserts, case reports of this type have waned in recent years based on a review of the literature.…”

Fracture of a cemented modern titanium alloy tibia baseplate: a case report

“…3 This number has increased slightly but remains a rare finding with few cases being described since that time frame, and even less so with a contemporary component. [4][5][6][7][8] This case report represents, to our knowledge, the first case report of a Zimmer® NexGen® tibia tray fracture, 77months from the index operation.…”

“…4 Ho et al, 15 described a case of a Duracon (Howmedica) basetray fracture at 3years in the setting of significant femoral component malposition. 15 Mineta et al discussed a case of an Miller Galante II (Zimmer) tibial baseplate fracture 16-years after initial knee arthroplasty, 5 the complication ultimately attributed to varus malalignment of the tibial basetray. Another report on Miller Galante II (Zimmer) tibial baseplate fracture was attributed to under sizing the tray, malrotation, and deficient proximal tibia bone stock.…”

Radiographic False Evidence of a Tibial Baseplate Fracture After Total Knee Arthroplasty

“…Proposed mechanisms leading to late baseplate fractures include malalignment and fatigue failure, bone loss due to osteolysis, undersizing, and elevated patient weight. [ 3 , 4 , 7 ].…”