Angled Polyethylene Insert Exchange for Sagittal Tibial Malalignment in Total Knee Arthroplasty

Tibial component malposition in total knee arthroplasty can cause early failure and result in the need for revision surgery. Excessive posterior slope of the tibial component is an uncommon, but difficult problem to correct. Component revision risks additional loss of deficient posterior tibial bone stock. As an alternative, a custom-made angled insert can correct for component malalignment and possibly avoid prosthesis revision. In this report, we present the use of a custom-angled bearing for sagittal alignment correction with 6-year follow-up. The procedure is simple and has little risk, but the cost, potential limitations for correcting excessive deformity, and uncertainty of long-term results make the use of angled inserts a rare and selective procedure. However, when possible to use, an angled insert may be a useful alternative to complete prosthetic revision.