Bilateral condyle fracture of tibial insert in mobile bearing total knee arthroplasty

We report a case of polyethylene insert breakage in a 45-year-old man after 3.5 years of cruciate retaining type mobile bearing total knee arthroplasty (TKA). Interstingly, both condyles of the polyethylene insert have fractured. The visual assessment done by stereoscopic microscope in the investigation report suggested that the fracture propagation was a result of cyclic loading and that the fracture was from the articular surface as a result of tibio-femoral and anteroposterior shear loading. The initial flexion-extension gap mismatch and/or specific Asian habits like kneeling or deep knee bending could have been the possible factors for over-stress for the insert causing this complication. After replacement of the broken insert and modification for daily activity preventing deep knee flexion, the patient obtained complete relief of previous symptoms. It remains unclear whether insert breakage was secondary to polyethylene insufficient design or to the polyethylene material fracture propagation.