Fracture of the polyethylene tibial post in the posterior-stabilized total knee prosthesis: arthrographic and CT arthrographic diagnosis

  • Yung Hsu
  • Chien-Hung Lin
  • Ginger H. F. Shu
  • Tsyh-Jyi Hsieh
  • Clement Kuen-Huang ChenEmail author
Case Report


Fracture of the polyethylene tibial post in the posterior-stabilized total knee prosthesis is often delayed in diagnosis due to its nonspecific symptoms and the radiolucent characteristic of polyethylene on conventional radiography. Therefore, the diagnosis is always established by arthroscopy. Notwithstanding recent advances in imaging modalities, we are presently aware of only two related case reports on MRI and even no reports about arthrographic or CT-arthrographic diagnosis of fractured tibial post. We hereby report a case of a 58-year-old female patient who developed recurrent knee pain during the third year after total knee arthroplasty. The displaced polyethylene tibial post was clearly outlined by administered contrast material in the posterior knee. Under the diagnosis of fracture of the tibial post, the patient underwent isolated replacement of the broken polyethylene insert. Her knee pain significantly improved after the operation.


Total knee arthroplasty Posterior-stabilized design Tibial post fracture CT arthrography 



We would like to acknowledge the surgical team in the Department of Orthopedics of the Chi Mei Medical Center for their input in discussion of arthroscopic and operative results. We are also grateful to Chen Hsu, who illustrated the figure for our manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Mulcahy H, Chew FS. Current concepts in knee replacement: features and imaging assessment. AJR Am J Roentgenol. 2013;201(6):W828–42.CrossRefGoogle Scholar
  2. 2.
    Chiu YS, Chen WM, Huang CK, Chiang CC, Chen TH. Fracture of the polyethylene tibial post in a NexGen posterior-stabilized knee prosthesis. J Arthroplast. 2004;19(8):1045–9.CrossRefGoogle Scholar
  3. 3.
    Kumar N, Yadav C, Raj R, Yadav S. Fracture of the polyethylene tibial post in a posterior stabilized knee prosthesis: a case report and review of literature. J Orthop. 2015;12(3):160–3.CrossRefGoogle Scholar
  4. 4.
    Lim HC, Bae JH, Hwang JH, Kim SJ, Yoon JY. Fracture of a polyethylene tibial post in a Scorpio posterior-stabilized knee prosthesis. Clin Orthop Surg. 2009;1(2):118–21.CrossRefGoogle Scholar
  5. 5.
    Mauerhan DR. Fracture of the polyethylene tibial post in a posterior cruciate-substituting total knee arthroplasty mimicking patellar clunk syndrome: a report of 5 cases. J Arthroplast. 2003;18(7):942–5.CrossRefGoogle Scholar
  6. 6.
    Rodes SA, Colosimo AJ, Hasselfeld KA. Polyethylene tibial post fracture in a posterior stabilized (genesis II) total knee arthroplasty. J Knee Surg Rep. 2015;1(01):060–3.CrossRefGoogle Scholar
  7. 7.
    Fritz J, Lurie B, Potter HGMR. Imaging of knee arthroplasty implants. Radiographic. 2015;35(5):1483–501.CrossRefGoogle Scholar
  8. 8.
    Mallo GC, Stanat SJ, Jones JA, Capozzi JD, Luchs JS. Catastrophic polyethylene failure diagnosed with magnetic resonance imaging in a painful total knee arthroplasty. J Arthroplast. 2011;26(3):505.e513–05.CrossRefGoogle Scholar
  9. 9.
    Li AE, Sneag DB, Miller TT, Lipman JD, Padgett DE. Potter HG. MRI of polyethylene tibial inserts in total knee arthroplasty: normal and abnormal appearances. AJR Am J Roentgenol. 2016;206(6):1264–71.CrossRefGoogle Scholar
  10. 10.
    Li G, Papannagari R, Most E, Park SE, Johnson T, Tanamal L, et al. Anterior tibial post impingement in a posterior stabilized total knee arthroplasty. J Orthop Res. 2005;23(3):536–41.CrossRefGoogle Scholar
  11. 11.
    Argenson JN, Parratte S, Ashour A, Saintmard B, Aubaniac JM. The outcome of rotating-platform total knee arthroplasty with cement at a minimum of ten years of follow-up. J Bone Joint Surg Am. 2012;94(7):638–44.CrossRefGoogle Scholar
  12. 12.
    Kobayashi H, Mitsugi N, Mochida Y, Taki N, Akamatsu Y, Aratake M, et al. Mid-term results of Stryker® Scorpio plus mobile-bearing total knee arthroplasty. Sports Med Arthrosc Rehabil Ther Technol. 2012;4(1):38.CrossRefGoogle Scholar
  13. 13.
    Tanikake Y, Hayashi K, Ogawa M, Inagaki Y, Kawate K, Tomita T, et al. Nontraumatic tibial polyethylene insert cone fracture in mobile-bearing posterior-stabilized total knee arthroplasty. Arthroplast Today. 2016;2(4):157–63.CrossRefGoogle Scholar
  14. 14.
    Capella M, Dolfin M, Saccia F. Mobile bearing and fixed bearing total knee arthroplasty. Ann Transl Med. 2016;4(7):127.CrossRefGoogle Scholar
  15. 15.
    Lachiewicz PF. How to treat a tibial post fracture in total knee arthroplasty? A systematic review. Clin Orthop Relat Res. 2011;469(6):1709–15.CrossRefGoogle Scholar
  16. 16.
    Pang HN, Bin Abd Razak HR, Petis S, Naudie DDR, MacDonald SJ. The role of isolated polyethylene exchange in total knee arthroplasty. EFORT Open Rev. 2017;2(3):66–71.CrossRefGoogle Scholar
  17. 17.
    Willson SE, Munro ML, Sandwell JC, Ezzet KA, Colwell CW Jr. Isolated tibial polyethylene insert exchange outcomes after total knee arthroplasty. Clin Orthop Relat Res. 2010;468(1):96–101.CrossRefGoogle Scholar
  18. 18.
    Deshmane PP, Rathod PA, Deshmukh AJ, Rodriguez JA, Scuderi GR. Symptomatic flexion instability in posterior stabilized primary total knee arthroplasty. Orthopedics. 2014;37(9):e768–74.CrossRefGoogle Scholar

Copyright information

© ISS 2019

Authors and Affiliations

  • Yung Hsu
    • 1
  • Chien-Hung Lin
    • 1
  • Ginger H. F. Shu
    • 2
  • Tsyh-Jyi Hsieh
    • 1
  • Clement Kuen-Huang Chen
    • 1
    Email author
  1. 1.Department of Medical ImagingChi Mei Medical CenterTainan CityTaiwan
  2. 2.Department of Medical ImagingChi Mei Medical CenterTainan CityTaiwan

Personalised recommendations