Mechanical complications have been underemphasized in reports on total knee arthroplasty (TKA) in obese patients. Noticing an increased prevalence of varus collapse of the tibia in obese total knee patients, we sought to determine if variability in proximal tibial cancellous bone strength played a role in failure. We attempted to define a cancellous threshold above which alternative methods of fixation should be used.
One thousand one hundred six revision TKAs from 2004-2014 identified 35 patients with varus collapse of the tibia, defined as a change in component position of >10°. Variables analyzed included weight, alignment, component size, and proximal tibial bone stress. Postoperative alignment was compared with prerevision alignment. To calculate tibial stress the following formula was used: mass (kg) × acceleration of gravity (9.8 m/s
Twenty-nine of 35 patients weighed >200 lbs, whereas 17 of 35 patients weighed >250 lbs (range 130-354 lbs). Average body mass index was 40.5 kg/m
Despite good initial primary TKA alignment, we report catastrophic varus collapse of tibial components in obese patients with small tibial components. When a cancellous threshold of 300,000 Pascals is exceeded, strong consideration should be given to either optimizing the patient's weight or using a longer tibial stem to dissipate forces on proximal tibia.