Revision TKA for Malrotation and Stiffness


This is an active, retired 70 year old avid golfer who underwent left knee replacement at an outside institution. He underwent a knee manipulation postoperatively due to significant stiffness. Unfortunately, he failed to regain his range of motion and at one year, he had ROM of 5 to 85 degrees. He complained of not being able to sit in tight spaces and chronic knee discomfort. X-rays demonstrated a well fixed and appropriately placed total knee replacement.

The patient saw Dr. Chen for a second opinion. After infection was ruled out, a CT scan was obtained. It demonstrated moderate malrotation of the components, causing the stiffness. He underwent TKA revision. After all components were removed, the tibial reconstruction was accomplished using a trabecular metal cone and a short cemented tibial stem construct. The femur was stemmed using a hybrid technique. The knee was meticulously balanced in flexion and extension to allow for maximal range of motion and future function. As a result, a posterior stabilized (PS) insert was able to be used instead of a constrained device.


At 6 months, the patient is ecstatic about his outcome. His range of motion is 0 to 125 degrees. He has no pain, excellent function, and an improved golf game.