Breaking Metal and Bone - Multiple Consecutive TKA and DFR Failures in a Cyclist: A Case Report

Background: This is the first reported case, to our knowledge, of progressive implant failure in a professional cyclist due to internal tibial rotation following varus correction osteotomy, aggravated by sport-specific mechanics.It emphasizes the necessity of rotational assessment and activity modification in high-performance patients, offering novel insights into longterm failure mechanisms. Case presentation:A professional cyclist underwent an elective distraction osteotomy in 1997 to correct varus malalignment, resulting in severe internal rotation deformity of the distal tibia.The patient experienced five additional surgeries in 16 years follow-up due to progressive complications, including fractures of the femur and implant components.High-intensity cycling with clipless pedals exacerbated the rotational misalignment, subjecting implants to unanticipated forces. Conclusion:This underscores the importance of preoperative assessment for rotational deformities and postoperative activity modifications in high-demand athletes.The interaction between biomechanical misalignment and repetitive cycling motion highlights a rare mechanism of implant failure, providing insight into optimizing outcomes.