Total Knee Arthroplasty with Significant Osteolysis following Gore-Tex Anterior Cruciate Ligament Reconstruction: Recommendations on Reducing Risk of Arthroplasty Failure

Abstract

Synthetic substitutes for ligament reconstruction surgery have been widely used in orthopaedic surgery; however, many have been susceptible to mechanical failure and associated with osteolysis. A 58-year-old male underwent total knee arthroplasty (TKA) for valgus knee osteoarthritis on the background of a Gore-Tex anterior cruciate ligament reconstruction over 30 years prior. Radiographic imaging preoperatively demonstrated extensive osteolysis, particularly on the tibial side. At the time of arthroplasty, the extent of osteolysis was noted to be greater than that on the preoperative imaging. The patient underwent a robotic-assisted TKA with the use of a cemented stemmed tibial prosthesis and bone grafting. The patient was prescribed a period of protected weightbearing following the procedure. Our recommendations for undertaking arthroplasty with a Gore-Tex graft in situ are as follows: (1) thorough preoperative workup including computed tomography imaging to identify tunnel widening and osteolysis; (2) ensure that additional bone allograft is available for the procedure; (3) use of cemented implants where there has been significant osteolysis; (4) removal of the entire synthetic graft with copious irrigation post-removal to ensure the joint does not remain exposed to particulate debris; (5) grafting of the tunnels and bone defects post-removal of synthetic graft; (6) use of a stemmed prosthesis to bypass any cortical defects and reduce the risk of subsidence of the component.

Keywords

• knee
• arthroplasty
• replacement
• knee
• arthroplasty
• polytetrafluoroethylene (gore-tex)
• osteolysis