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The Journal of Bone and Joint Surgery, Vol 70, Issue 5 668-674, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Failure of the metal-backed patellar component after total knee replacement
JC Bayley, RD Scott, FC Ewald and GB Holmes
West Roxbury/Brockton Veterans Administration Medical Center, Massachusetts 02132.
Twenty-five patients had failure of a metal-backed patellar component after
total knee replacement. Five manufacturers and seven designs were involved.
There was no apparent correlation between failure of the component and the
age or sex of the patient, the diagnosis, the use of cement, the
femorotibial alignment, or the use of lateral release. The patients in whom
the patellar implant failed were relatively heavy, and the diagnosis in
most of them was osteoarthritis. The failure was due to one of two
mechanisms: wear or fracture, or both, of the polyethylene over the edge of
the metal backing (eighteen components), or dissociation of the
polyethylene or the base-plate, or both, from the anchoring pegs (seven
components). In many of the patients, failure of the component was not
suspected before arthrotomy. The failure led to considerable wear of the
femoral component in eleven patients and to metal-induced synovitis in
twenty-three. We concluded that metal backing may predispose the patellar
component to a small but important likelihood of failure, and we urge
caution in choosing a metal-backed patellar implant. Additional research is
necessary to improve designs for the patellar component, especially if
metal backing is to be used.
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