Polyethylene Failure of the Patellar Component in New Jersey Low-Contact Stress Total Knee Arthroplasties

In a postoperative 5- to 12-year follow-up study of 598 New Jersey low-contact stress total knee arthroplasties, 32 required revision. All retrieved patellar components were examined for polyethylene damage. These 32 cases had 3 types of failure: split rupture (7 cases), peripheral wear (21), and cantilevering breakage (4), respectively 75%, 64.3%, and 100% of which showed subluxation and/or tilting of the patellar component on the prerevision roentgenograms. Misalignment at the joint contact surfaces and rotational blockage of the mobile patellar component were considered the major causes of the failure. A design of a flatter metallic button (giving larger focal thickness of the polyethylene) and a dome-shaped polyethylene (reducing stress concentration at the pinnacle) may alleviate the failure driving mechanism should subluxation or tilting of the patellar component take place.