This report details 16 cases of focal posteromedial tibial polyethylene wear and failure after total knee arthroplasty. This wear phenomenon was associated with an external rotatory subluxation of the tibial component relative to the femoral component. Failure occurred in ten Miller Galante 1, three Porous Coated Anatomic, two Kinematic, and one Press-Fit Condylar knee designs at a mean time of 45 months from their implantation. With this type of failure, there did not seem to be a relationship with metal type, fixation, polyethylene manufacturing method, or polyethylene thickness. A relatively flat design of the tibial articular surface was common to all of these components. In certain patients this articular design may allow excessive component translation, which leads to polyethylene deformity, wear, and subluxation. Some methods for preventing this failure mode are reported here.