{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:23:24Z","timestamp":1787657004715,"version":"build-2736575974"},"reference-count":19,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,5]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>Catastrophic implant failure is a rare complication after total knee arthroplasty (TKA) that can lead to metallosis and pseudotumour formation requiring complex revision surgery. This case report describes a man in his 60s who presented with progressive knee pain, a squeaking implant and ligamentous instability 20 years post-primary TKA. Imaging demonstrated polyethylene failure, tibial baseplate breakage, extensive osteolysis and metallosis. The patient underwent a revision procedure with a distal femur replacement (DFR). Postoperatively he had no complications, re-admissions or revision surgery. At 4 years post DFR, he remained asymptomatic with excellent functional outcomes (Oxford Knee Score 45 out of 48; Forgotten Joint Score 98 out of 100). This case highlights DFR as a viable salvage option in appropriately selected patients where conventional revision TKA is not possible.<\/jats:p>","DOI":"10.1136\/bcr-2026-272954","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:05:13Z","timestamp":1787655913000},"page":"e272954","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Distal femur replacement after catastrophic failure of a total knee arthroplasty"],"prefix":"10.1136","volume":"19","author":[{"given":"Alex","family":"Rice","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, The Prince Charles Hospital, Chermside, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2035-838X","authenticated-orcid":false,"given":"Parvati","family":"Dadwal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Witherow","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Menegon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2446-5326","authenticated-orcid":false,"given":"Chris","family":"Wall","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"2026082504050750000_19.8.e272954.1","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.jcot.2019.04.010","article-title":"Severe metallosis-related osteolysis as a cause of failure after total knee replacement","volume":"11","author":"Salem","year":"2020","journal-title":"J Clin Orthop Trauma"},{"key":"2026082504050750000_19.8.e272954.2","doi-asserted-by":"crossref","unstructured":"Lewis PL , Gill DR , McAuliffe MJ , et al . 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