Revision Total Knee Arthroplasty for Excessive Ligamentotaxis

Correction of varus/valgus deformity via soft tissue balancing is the accepted technique in knee arthroplasty surgery. However, in rare instances, excessive ligamentotaxis can result in overly stretched periarticular structures leading to pain and impaired function. This has been called the “joint jack phenomenon.” We report a case in which a very thick polyethylene insert resulted in a painful knee and leg length discrepancy. Our solution was to use a salvage hinge knee arthroplasty to achieve joint space reduction, restore equal leg lengths, and avoid global instability. We believe this is the first report of a surgical reduction procedure to address this specific clinical problem.