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Case report
Knee arthroplasty with hardware removal: complication cascade. Is it preventable?
  1. Gabriel Nierenberg1,2,
  2. Alaa Abu Elasal2,
  3. Eran Keltz1,2 and
  4. Doron Norman1,2
  1. 1Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel
  2. 2Technion Israel Institute of Technology Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
  1. Correspondence to Dr Gabriel Nierenberg; Drgabiknee{at}


An elderly woman underwent hardware removal and total joint replacement (TJR) of her right knee. Ipsilateral total tip replacement was performed 7 years earlier, and 12 months later, a supracondylar fracture of the index femur was successfully treated by open reduction internal fixation (ORIF) of the distal femur with a locking compression plate condylar plate. Hardware removal attempt, prior to the arthroplasty, resulted in fracture of the distal femur. Total knee replacement (TKR) was commenced with temporary reduction and final stabilisation of the femur fracture with a condylar plate. Postoperatively, non-union of the femur fracture developed twice with fatigue failure of the plate fixation device in both instances. Refixation of the femur was performed on both occasions and additional bone healing augmentation measures were performed for each subsequent surgery. Femur union was achieved fourteen months after the last surgery.

  • orthopaedic and trauma surgery
  • osteoarthritic knww

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  • Contributors GN: chief knee reconstruction surgeon; reporting; concept and design of manuscript. AAE: reporting; data acquisition. EK: junior trauma surgeon; concept and design of manuscript; editing; follow-up. DN: chief trauma surgeon; reporting; follow-up. All authors made a substantial contribution to the debriefing of this complicated case and bringing this case report and paradigm analysis to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.