Volume 2, Issue 4, Pages (December 2016)

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Volume 2, Issue 4, Pages 157-163 (December 2016) Nontraumatic tibial polyethylene insert cone fracture in mobile-bearing posterior- stabilized total knee arthroplasty  Yohei Tanikake, Koji Hayashi, Munehiro Ogawa, Yusuke Inagaki, Kenji Kawate, Tetsuya Tomita, Yasuhito Tanaka  Arthroplasty Today  Volume 2, Issue 4, Pages 157-163 (December 2016) DOI: 10.1016/j.artd.2016.05.006 Copyright © 2016 The Authors Terms and Conditions

Figure 1 Preoperative radiographs. (a) Anteroposterior, (b) lateral, (c) Merchant, and (d) full-length. Arthroplasty Today 2016 2, 157-163DOI: (10.1016/j.artd.2016.05.006) Copyright © 2016 The Authors Terms and Conditions

Figure 2 Postoperative radiographs. Only axial view was photographed after an operation for one week. (a) Anteroposterior, (b) lateral, (c) Merchant, and (d) full-length. Arthroplasty Today 2016 2, 157-163DOI: (10.1016/j.artd.2016.05.006) Copyright © 2016 The Authors Terms and Conditions

Figure 3 Radiographs of the dislocated tibial insert. Arthroplasty Today 2016 2, 157-163DOI: (10.1016/j.artd.2016.05.006) Copyright © 2016 The Authors Terms and Conditions

Figure 4 Intraoperative photographs. (a) The tibial insert was easily dislocated due to the fracture at the cone base of the tibial insert. (b) Front of the tibial insert. (c) Top of the fractured cone and tibial insert. (d) Bottom of the tibial insert. Arthroplasty Today 2016 2, 157-163DOI: (10.1016/j.artd.2016.05.006) Copyright © 2016 The Authors Terms and Conditions

Figure 5 Photomicrographed fracture surface of the tibial insert. (a) Photomicrographed fracture surface on the cone side. A raised striation marking is observed in the upper area encircled in red. The center opening is a hole drilled for removal at the time of the replacement surgery. (b) Fracture surface on the insert side. A protrusion is observed in the blue ellipse area; however, it did not correspond with the contour of the fracture surface in (a). Alphabets A through E in the photomicrograph express arbitrary positions on the fracture surface. Arthroplasty Today 2016 2, 157-163DOI: (10.1016/j.artd.2016.05.006) Copyright © 2016 The Authors Terms and Conditions

Figure 6 Overall SEM images. (a) Fracture surface on the cone side. (b) Fracture surface on the insert side. Locations A through E roughly correspond with those on the photomicrographic images in Fig. 5. Arthroplasty Today 2016 2, 157-163DOI: (10.1016/j.artd.2016.05.006) Copyright © 2016 The Authors Terms and Conditions

Figure 7 Visual field A. (a) Visual field A in Fig. 6a (×50 magnification). (b) The area enclosed by the yellow square in (a) (×200 magnification). (c) The area enclosed by the yellow square in (b) (×2000 magnification). Arthroplasty Today 2016 2, 157-163DOI: (10.1016/j.artd.2016.05.006) Copyright © 2016 The Authors Terms and Conditions

Figure 8 Visual field B. (a) Visual field B in Fig. 6a (×30 magnification). (b) The area enclosed by the yellow square in (a) (×150 magnification). (c) The area enclosed by the yellow square in (b) (×1000 magnification). Arthroplasty Today 2016 2, 157-163DOI: (10.1016/j.artd.2016.05.006) Copyright © 2016 The Authors Terms and Conditions

Figure 9 Visual field C. (a) Visual field C in Fig. 6a (×50 magnification). (b) The area enclosed by the yellow square in (a) (×200 magnification). (c) The area enclosed by the yellow square in (b) (×2000 magnification). Arthroplasty Today 2016 2, 157-163DOI: (10.1016/j.artd.2016.05.006) Copyright © 2016 The Authors Terms and Conditions

Figure 10 Visual field D. (a) Visual field D in Fig. 6a (×30 magnification). (b) The area enclosed by the yellow square in (a) (×150 magnification). (c) The area enclosed by the yellow square in (b) (×1000 magnification). Arthroplasty Today 2016 2, 157-163DOI: (10.1016/j.artd.2016.05.006) Copyright © 2016 The Authors Terms and Conditions

Figure 11 Visual field E. (a) Visual field E in Fig. 6a (×30 magnification). (b) The area enclosed by the yellow square in (a) (×150 magnification). (c) The area enclosed by the yellow square in (b) (×1000 magnification). Arthroplasty Today 2016 2, 157-163DOI: (10.1016/j.artd.2016.05.006) Copyright © 2016 The Authors Terms and Conditions

Figure 12 Side view of the fractured tibial insert. Arthroplasty Today 2016 2, 157-163DOI: (10.1016/j.artd.2016.05.006) Copyright © 2016 The Authors Terms and Conditions

Figure 13 Axial rotation angle of the femoral component to tibial component at each flexion angle. Arthroplasty Today 2016 2, 157-163DOI: (10.1016/j.artd.2016.05.006) Copyright © 2016 The Authors Terms and Conditions

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