{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:02:54Z","timestamp":1787068974478,"version":"build-2736575974"},"reference-count":73,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: The use of modular components provides several advantages in total knee arthroplasty (TKA), including exchange of the polyethylene insert while retaining the stable components in the revision TKA. Compared to full, non-modular component revision TKA, isolated polyethylene exchange (IPE) has the advantage of decreased morbidity, faster rehabilitation, and acceptable outcomes. Methods: A review of published literature on revision TKA was conducted, with a specific focus on studies evaluating the use of IPE for managing complications such as stiffness, instability, and periprosthetic joint infection (PJI). Results: IPE with downsizing may be considered for patients with mild stiffness and stable, well-positioned implants that have increased polyethylene thickness, though expectations for motion gain should be cautious. There is no clear consensus on IPE for instability. Some studies report high re-revision rates, while others show clinical and functional improvement when the TKA is well-aligned, well-fixed, and intraoperative gap balance is achieved. Additionally, irrigation and debridement with polyethylene exchange (IDPE) may be effective for acute TKA PJI management, particularly within the first two weeks of symptom onset. Conclusions: Based on current literature, IPE in aseptic TKA revisions may be effective for stiffness or instability when implants are well-fixed and well-aligned\u2014particularly if polyethylene constraint can be adjusted for instability or downsized for stiffness. The role of IDPE in acute TKA PJI is better defined in the literature, with strong emphasis on its time-sensitive effectiveness\u2014most notably within the first two weeks of symptom onset.<\/jats:p>","DOI":"10.3390\/jcm14196779","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T12:05:13Z","timestamp":1758801913000},"page":"6779","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Isolated Polyethylene Exchange in Revision Total Knee Arthroplasty: A Review of Indications and Outcomes"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3267-2740","authenticated-orcid":false,"given":"Alex M.","family":"Moses","sequence":"first","affiliation":[{"name":"UF Health Jacksonville, Jacksonville, FL 32209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela E.","family":"Cushing","sequence":"additional","affiliation":[{"name":"UF Health Jacksonville, Jacksonville, FL 32209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mason A.","family":"Fawcett","sequence":"additional","affiliation":[{"name":"UF Health Jacksonville, Jacksonville, FL 32209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Dohse","sequence":"additional","affiliation":[{"name":"UF Health Jacksonville, Jacksonville, FL 32209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obinna O.","family":"Adigweme","sequence":"additional","affiliation":[{"name":"Orlando Orthopaedic Center, Orlando, FL 32806, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0193-983X","authenticated-orcid":false,"given":"Cameron K.","family":"Ledford","sequence":"additional","affiliation":[{"name":"Mayo Clinic Jacksonville, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2598","DOI":"10.1016\/j.arth.2017.02.069","article-title":"Total Knee Arthroplasty for Osteoarthritis in Patients Less Than Fifty-Five Years of Age: A Systematic Review","volume":"32","author":"Aujla","year":"2017","journal-title":"J. Arthroplast."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ocl.2017.08.002","article-title":"Outpatient Total Knee Arthroplasty","volume":"49","author":"Krause","year":"2018","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2663","DOI":"10.1016\/j.arth.2017.03.066","article-title":"Current Epidemiology of Revision Total Knee Arthroplasty in the United States","volume":"32","author":"Delanois","year":"2017","journal-title":"J. Arthroplast."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"516","DOI":"10.2106\/00004623-200004000-00007","article-title":"Clinical Results of Modular Polyethylene Insert Exchange with Retention of Total Knee Arthroplasty Components","volume":"82","author":"Engh","year":"2000","journal-title":"J. Bone Jt. Surg.-Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.knee.2009.11.008","article-title":"The role of the cemented all-polyethylene tibial component in total knee replacement: A 30-year patient follow-up and review of the literature","volume":"17","author":"Blumenfeld","year":"2010","journal-title":"Knee"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"225","DOI":"10.21037\/atm.2017.02.25","article-title":"Modular versus nonmodular tibial inserts in total knee arthroplasty: What are the differences?","volume":"5","author":"Makhdom","year":"2017","journal-title":"Ann. Transl. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.knee.2009.01.005","article-title":"Comparison between highly cross-linked and conventional polyethylene in total knee arthroplasty","volume":"16","author":"Minoda","year":"2009","journal-title":"Knee"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2798","DOI":"10.1007\/s11999-008-0470-6","article-title":"Polyethylene wear is influenced by manufacturing technique in modular TKA","volume":"466","author":"Lombardi","year":"2008","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S80","DOI":"10.5435\/00124635-200800001-00017","article-title":"How have new sterilization techniques and new forms of polyethylene influenced wear in total joint replacement?","volume":"16","author":"Crowninshield","year":"2008","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1302\/0301-620X.99B8.BJJ-2017-0028.R1","article-title":"The use of highly crosslinked polyethylene in total knee arthroplasty","volume":"99-B","author":"Brown","year":"2017","journal-title":"Bone Jt. J."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Hasegawa, M., Tone, S., Naito, Y., and Sudo, A. (2023). Ultra-High-Molecular-Weight Polyethylene in Hip and Knee Arthroplasties. Materials, 16.","DOI":"10.3390\/ma16062140"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2806","DOI":"10.1007\/s11999-008-0472-4","article-title":"Highly crosslinked polyethylene is safe for use in total knee arthroplasty","volume":"466","author":"Hodrick","year":"2008","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2262","DOI":"10.1007\/s11999-011-1872-4","article-title":"History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene","volume":"469","author":"Kurtz","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1302\/0301-620X.103B11.BJJ-2020-2334.R1","article-title":"What factors drive polyethylene wear in total knee arthroplasty? Results of a large retrieval series","volume":"103-B","author":"Currier","year":"2021","journal-title":"Bone Jt. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e58","DOI":"10.2106\/JBJS.24.00857","article-title":"Delamination and Oxidation in Compression-Molded Polyethylene","volume":"107","author":"Nickel","year":"2025","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5435\/00124635-200701000-00006","article-title":"Wear and osteolysis around total knee arthroplasty","volume":"15","author":"Naudie","year":"2007","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"715","DOI":"10.2106\/JBJS.M.01534","article-title":"Current failure mechanisms after knee arthroplasty have changed: Polyethylene wear is less common in revision surgery","volume":"97","author":"Thiele","year":"2015","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1007\/s11999-014-3540-y","article-title":"Current modes of failure in TKA: Infection, instability, and stiffness predominate","volume":"472","author":"Le","year":"2014","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1007\/s00402-020-03560-x","article-title":"Metallosis after knee replacement: A review","volume":"140","author":"Sahan","year":"2020","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1016\/j.knee.2020.01.002","article-title":"Revisiting the role of isolated polyethylene exchange for aseptic failures in total knee arthroplasty","volume":"27","author":"Duensing","year":"2020","journal-title":"Knee"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/s11999-011-1997-5","article-title":"Polyethylene quality affects revision knee liner exchange survivorship","volume":"470","author":"Engh","year":"2012","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"173","DOI":"10.5435\/JAAOS-D-13-00189","article-title":"Evaluating the progression of osteolysis after total knee arthroplasty","volume":"23","author":"Dalling","year":"2015","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.2106\/00004623-200209000-00005","article-title":"Surface damage in machined ram-extruded and net-shape molded retrieved polyethylene tibial inserts of total knee replacements","volume":"84","author":"Berzins","year":"2002","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1007\/s00402-021-03887-z","article-title":"Highly cross-linked polyethylene in primary total knee arthroplasty is associated with a lower rate of revision for aseptic loosening: A meta-analysis of 962,467 cases","volume":"142","author":"Gkiatas","year":"2022","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_25","first-page":"518","article-title":"Five-year migration and insert wear of uncemented tibial components with either conventional polyethylene or sequentially annealed highly crosslinked polyethylene inserts: A blinded randomized controlled trial using radiostereometric analysis","volume":"105 Pt B","author":"Kaptein","year":"2023","journal-title":"Bone Jt. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.2106\/00004623-200407000-00017","article-title":"Stiffness after total knee arthroplasty. Prevalence of the complication and outcomes of revision","volume":"86","author":"Kim","year":"2004","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.arth.2004.02.008","article-title":"Stiffness after total knee arthroplasty","volume":"19","author":"Laskin","year":"2004","journal-title":"J. Arthroplast."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"311","DOI":"10.5435\/00124635-199909000-00004","article-title":"Aseptic complications after total knee arthroplasty","volume":"7","author":"Lonner","year":"1999","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/0968-0160(94)90022-1","article-title":"Knee ankylosis or stiffness after a total knee arthroplasty: Treatment and long-term outcome","volume":"1","author":"Papagelopoulos","year":"1994","journal-title":"Knee"},{"key":"ref_30","first-page":"316","article-title":"Timing of manipulation under anaesthesia for stiffness after total knee arthroplasty","volume":"3","author":"Mamarelis","year":"2015","journal-title":"Ann. Transl. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.2106\/00004623-200110000-00012","article-title":"Poor outcomes of isolated tibial insert exchange and arthrolysis for the management of stiffness following total knee arthroplasty","volume":"83","author":"Babis","year":"2001","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/01.blo.0000214419.36959.8c","article-title":"Surgical treatment and customized rehabilitation for stiff knee arthroplasties","volume":"446","author":"Mont","year":"2006","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/01.blo.0000185312.43955.c8","article-title":"Revision total knee arthroplasty for restricted motion","volume":"440","author":"Keeney","year":"2005","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2952","DOI":"10.1016\/j.arth.2018.05.013","article-title":"Protocol-Driven Revision for Stiffness After Total Knee Arthroplasty Improves Motion and Clinical Outcomes","volume":"33","author":"Hug","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1016\/j.arth.2024.04.008","article-title":"A Comparison Between Polyethylene Exchange and Full Revision for Arthrofibrosis Following Total Knee Arthroplasty","volume":"39","author":"Dubin","year":"2024","journal-title":"J. Arthroplast."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/j.arth.2020.09.005","article-title":"Outcome of Revision Surgery for the Idiopathic Stiff Total Knee Arthroplasty","volume":"36","author":"Xiong","year":"2021","journal-title":"J. Arthroplast."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.artd.2022.03.004","article-title":"Epidemiology of Revision Total Knee Arthroplasty in the United States, 2012 to 2019","volume":"15","author":"Hsiue","year":"2022","journal-title":"Arthroplast. Today"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.arth.2006.02.101","article-title":"The unstable total knee arthroplasty: Causes and cures","volume":"21","author":"Vince","year":"2006","journal-title":"J. Arthroplast."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"64","DOI":"10.2106\/00004623-200201000-00010","article-title":"The effectiveness of isolated tibial insert exchange in revision total knee arthroplasty","volume":"84","author":"Babis","year":"2002","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1097\/00003086-200212000-00023","article-title":"Polyethylene exchange only for prosthetic knee instability","volume":"405","author":"Brooks","year":"2002","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s11999-009-1023-3","article-title":"Isolated tibial polyethylene insert exchange outcomes after total knee arthroplasty","volume":"468","author":"Willson","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2946","DOI":"10.1016\/j.arth.2018.04.042","article-title":"Isolated Polyethylene Exchange With Increased Constraint Is Comparable to Component Revision TKA for Instability in Properly Selected Patients","volume":"33","author":"Cooper","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1016\/j.arth.2020.01.006","article-title":"Isolated Polyethylene Insert Exchange for Flexion Instability After Primary Total Knee Arthroplasty Demonstrated Excellent Results in Properly Selected Patients","volume":"35","author":"Green","year":"2020","journal-title":"J. Arthroplast."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1055\/s-0040-1721091","article-title":"Isolated Liner Revision for Total Knee Arthroplasty Instability: A Road That Should Remain Less Taken","volume":"35","author":"Tegethoff","year":"2022","journal-title":"J. Knee Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.arth.2023.09.007","article-title":"Isolated Liner Exchange Versus All-Component Revision for Instability After Total Knee Arthroplasty","volume":"39","author":"Debbi","year":"2024","journal-title":"J. Arthroplast."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1017\/ice.2023.10","article-title":"Longitudinal rates, risk factors, and costs of superficial and deep incisional surgical-site infection (SSI) after primary and revision total knee arthroplasty: A US retrospective claims database analysis","volume":"44","author":"Edmiston","year":"2023","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1055\/s-0041-1731324","article-title":"Analyzing the Burden of Revision Total Knee Arthroplasty in the United States between 2009 and 2016","volume":"36","author":"Livshetz","year":"2023","journal-title":"J. Knee Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1016\/j.arth.2013.11.026","article-title":"Mortality Following Revision Total Knee Arthroplasty: A Matched Cohort Study of Septic versus Aseptic Revisions","volume":"29","author":"Choi","year":"2014","journal-title":"J. Arthroplast."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1016\/j.arth.2016.01.021","article-title":"The Economic Impact of Periprosthetic Infections After Total Hip Arthroplasty at a Specialized Tertiary-Care Center","volume":"31","author":"Kapadia","year":"2016","journal-title":"J. Arthroplast."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1302\/2058-5241.4.180092","article-title":"Periprosthetic joint infection: Current concepts and outlook","volume":"4","author":"Izakovicova","year":"2019","journal-title":"EFORT Open Rev."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1002\/jor.24019","article-title":"Periprosthetic bacterial biofilm and quorum sensing","volume":"36","author":"Mooney","year":"2018","journal-title":"J. Orthop. Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.idc.2018.06.005","article-title":"Prosthetic Joint Infection Update","volume":"32","author":"Beam","year":"2018","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"379","DOI":"10.5194\/jbji-6-379-2021","article-title":"Long-term outcome of two-stage revision surgery after hip and knee prosthetic joint infections: An observational study","volume":"6","author":"Bourgonjen","year":"2021","journal-title":"J. Bone Jt. Infect."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"S327","DOI":"10.1016\/j.arth.2022.01.029","article-title":"Long Term Results of Two-Stage Revision for Chronic Periprosthetic Knee Infection: A Multicenter Study","volume":"37","author":"Kildow","year":"2022","journal-title":"J. Arthroplast."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.arth.2017.11.029","article-title":"A Multicenter Study of Irrigation and Debridement in Total Knee Arthroplasty Periprosthetic Joint Infection: Treatment Failure Is High","volume":"33","author":"Urish","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1872","DOI":"10.1016\/j.arth.2017.12.039","article-title":"Irrigation and Debridement for Early Periprosthetic Knee Infection: Is It Effective?","volume":"33","author":"Narayanan","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"172","DOI":"10.5792\/ksrr.16.040","article-title":"Efficacy of Open Debridement and Polyethylene Exchange in Strictly Selected Patients with Infection after Total Knee Arthroplasty","volume":"29","author":"Son","year":"2017","journal-title":"Knee Surg. Relat. Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1055\/s-0036-1579667","article-title":"Polyethylene Insert Exchange Is Crucial in Debridement for Acute Periprosthetic Infections following Total Knee Arthroplasty","volume":"30","author":"Zhang","year":"2017","journal-title":"J. Knee Surg."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1007\/s11999-010-1293-9","article-title":"A two-stage retention d\u00e9bridement protocol for acute periprosthetic joint infections","volume":"468","author":"Estes","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2505","DOI":"10.1016\/j.arth.2017.03.051","article-title":"Poor Outcomes of Irrigation and Debridement in Acute Periprosthetic Joint Infection With Antibiotic-Impregnated Calcium Sulfate Beads","volume":"32","author":"Flierl","year":"2017","journal-title":"J. Arthroplast."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/j.arth.2017.10.044","article-title":"Vancomycin Povidone-Iodine Protocol Improves Survivorship of Periprosthetic Joint Infection Treated with Irrigation and Debridement","volume":"33","author":"Riesgo","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.diagmicrobio.2018.08.012","article-title":"Staphylococcus aureus versus Staphylococcus epidermidis in periprosthetic joint infection-Outcome analysis of methicillin-resistant versus methicillin-susceptible strains","volume":"93","author":"Hischebeth","year":"2019","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s11999-010-1434-1","article-title":"The Chitranjan Ranawat Award: Fate of two-stage reimplantation after failed irrigation and d\u00e9bridement for periprosthetic knee infection","volume":"469","author":"Sherrell","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/j.knee.2018.07.003","article-title":"Factors affecting failure of irrigation and debridement with liner exchange in total knee arthroplasty infection","volume":"25","author":"Bene","year":"2018","journal-title":"Knee"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1016\/j.arth.2018.01.042","article-title":"Preoperative Anemia Is Associated with Failure of Open Debridement Polyethylene Exchange in Acute and Acute Hematogenous Prosthetic Joint Infection","volume":"33","author":"Swenson","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1056\/NEJMra2203477","article-title":"Periprosthetic Joint Infection","volume":"388","author":"Patel","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"S495","DOI":"10.1016\/j.arth.2025.05.077","article-title":"Treatment Approaches for Managing Periprosthetic Joint Infection Following Total Knee Arthroplasty: A Population-Based Analysis","volume":"40","author":"Wood","year":"2025","journal-title":"J. Arthroplast."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"451","DOI":"10.2106\/JBJS.21.00356","article-title":"Factors Affecting the Risk of Aseptic Patellar Complications in Primary TKA Performed with Cemented All-Polyethylene Patellar Resurfacing","volume":"104","author":"Limberg","year":"2022","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1503\/cjs.001617","article-title":"Understanding the patellofemoral joint in total knee arthroplasty","volume":"62","author":"Matz","year":"2019","journal-title":"Can. J. Surg."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1302\/0301-620X.105B12.BJJ-2023-0670.R1","article-title":"Cementless metal-backed patellar components in primary total knee arthroplasty using an implant of modern design","volume":"105-B","author":"Baker","year":"2023","journal-title":"Bone Jt. J."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2784","DOI":"10.1007\/s11999-008-0414-1","article-title":"Isolated all-polyethylene patellar revisions for metal-backed patellar failure","volume":"466","author":"Garcia","year":"2008","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s12306-022-00764-9","article-title":"Management of patella maltracking after total knee arthroplasty: A systematic review","volume":"107","author":"Ferri","year":"2023","journal-title":"Musculoskelet. Surg."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1016\/j.arth.2020.11.028","article-title":"Cost of Aseptic Revision Total Knee Arthroplasty at a Tertiary Medical Center","volume":"36","author":"Steele","year":"2021","journal-title":"J. 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