Joint instability stands out as one of the single most complex and prevalent mechanisms of structural failure following primary total knee arthroplasty (TKA), driving an estimated 11% to 26% of all secondary revision procedures nationwide. When a patient presents to the clinic complaining of deep mechanical pain, chronic joint effusions, or a persistent sensation of the knee “giving way” during knee-bending maneuvers, the surgical team faces a crucial decision. Should they perform a less invasive, tissue-preserving isolated tibial insert exchange (ITIE) popularly termed a “poly swap,” or proceed with an aggressive, morbid full component revision (FCR) of both the femoral and tibial hardware?
Historically, this choice has been complicated by conflicting registry evidence. Advocates of a quick poly exchange champion its clear clinical perks: preserved native bone stock, minimized operative times, lower cost, and significantly reduced systemic recovery strain.
