Eight years out from a TKA

Eight years out from a TKA, and the X-ray tells the story before the patient finishes the sentence.

Significant polyethylene wear. Gross instability. Infection workup negative. Cobalt and chromium both running 2x normal — the metal is involved now, not just the plastic.

In my OR, this is the fork I think about hardest: with instability plus metallosis on top of wear, is an isolated poly exchange ever enough — or has the metal damage already made that decision for you?

For the revision surgeons: where's your line? What pushes you from poly swap to full revision in a case like this — the instability pattern, the ion levels, what you find once you're in, or something else?

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