Tibial polyethylene post fractures at ten-years in a bicruciate stabilised (BCS) total knee arthroplasty design

This short paper reports a potential emerging mode of failure in three patients with a bicruciate stabilised (BCS) total knee arthroplasty.

Three patients presented to our institution with late instability ten years after undergoing total knee arthroplasty (Journey BCS) and were asymptomatic up to this point. Retrieval analysis was performed by an external body commissioned by the NHS and all three cases were reported to the UK Medicines and Healthcare Products Regulatory Agency (MHRA).

Two patients were revised through simple exchange with a polyethylene tibial insert. One patient underwent a full revision of femoral and tibial components. Intra-operative findings revealed that the polyethylene post had fractured in an identical manner in all three cases. Retrieval analysis demonstrated posterior impingement and wear of the polyethylene post resulting in fatigue failure.

This short paper highlights a potential emerging mode of failure with Journey BCS that requires wider dissemination to raise awareness among surgeons and calls for long-term follow up of those patients who received this specific implant. Early revision with polyethylene exchange is a successful treatment in patients when femoral and tibial components are well-positioned and well-fixed.