An Early Periprosthetic Fracture of a Cementless Oxford Unicompartmental Knee Arthroplasty: Risk Factors and Mitigation Strategies

Li, Zong Xian; Tan, Andrew Hwee Chye

doi:10.13107/jocr.2021.v11.i04.2156

Cited by 4 publications

(1 citation statement)

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“…This suggests that perioperative factors contribute more to fractures after UKR than after TKR. After UKR, early periprosthetic fractures tend to be tibial and to present a few weeks after the operation 34,35 . They are therefore likely to have been initiated at the operation and then propagated and completed due to stresses in the bone 36 .…”

Section: Discussionmentioning

confidence: 99%

A Comparison of the Periprosthetic Fracture Rate of Unicompartmental and Total Knee Replacements

Mohammad,

Barker,

Judge

et al. 2023

Journal of Bone and Joint Surgery

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Background: Periprosthetic fractures are rare but devastating complications of knee replacement, often requiring complex surgery with substantial morbidity and mortality. It is not known how the fracture rates after total knee replacement (TKR) and unicompartmental knee replacement (UKR) compare. We performed the first matched study comparing TKR and UKR periprosthetic fracture rates. Methods: This study involved 54,215 UKRs and 54,215 TKRs, identified in the National Joint Registry and Hospital Episodes Statistics database, which were propensity score-matched on patient and surgical factors. The International Classification of Diseases, Tenth Revision, (ICD-10) code M96.6 was used to identify periprosthetic fractures at ≤3 and >3 months postoperatively, as well as estimate rates at up to 10 years. Subgroup analyses were performed in different age groups (<55, 55 to 64, 65 to 74, and ≥75 years), body mass index (BMI) categories (normal, 18.5 to <25 kg/m2; overweight, 25 to <30 kg/m2; obese, 30 to <40 kg/m2; and morbidly obese, ≥40 kg/m2), and sexes. Results: The 3-month fracture rate was 0.09% (n = 50) in the UKR group and 0.05% (n = 25) in the TKR group, with this difference being significant (odds ratio [OR], 2.0; p = 0.004). The rate of fractures occurring at >3 months was 0.32% (n = 171) in the UKR group and 0.61% (n = 329) in the TKR group (OR, 0.51; p < 0.001). At 10 years, the cumulative incidence of fractures was 0.6% after UKR versus 1% after TKR (OR, 0.68; p < 0.001). Fracture rates increased with increasing age, decreasing BMI, and female sex for both UKRs and TKRs. Conclusions: The fracture risk was small after both UKR and TKR, with small absolute differences between implant types. During the first 3 postoperative months, the fracture rate after UKR was 0.1% and was about twice as high as that after TKR. However, over the first 10 years, the cumulative fracture rate after TKR was 1% and was almost twice as high as that after UKR. Fracture rates after both UKR and TKR were higher in women, patients ≥75 years of age, and patients with normal weight. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%