Femoral Component Fracture in a Total Knee Arthroplasty Patient With a Persistent Flexion Contracture

This article reports a rare case of a total knee arthroplasty femoral component fracture. Fractures of early knee systems were attributed to design flaws. Modern design failures have been attributed to poor surgical technique or underlying osteolysis. Here, we report a fracture in the Vanguard prosthesis (Zimmer Biomet, Warsaw, IN) 12 years after implantation in a patient with a persistent flexion contracture. The fracture likely occurred due to fatigue failure of the anterior flange secondary to increased stress from a high riding patella. Although femoral component fractures are rare, they should be considered as a potential complication, especially in patients with special load considerations. For these patients, it is essential that the prosthesis be properly supported with clean cuts and an adequate cement mantle.