Femoral Shaft Fracture Resulting From Femoral Tracker Placement in Navigated TKA

Abstract

Computer-assisted navigation is a surgical tool that may decrease malalignment outliers in TKA. With any new surgical technique, there is the possibility of unexpected complications that raise caution. We report two patients with displaced femoral fractures at optical tracker pin placement sites created for routine performance of navigated TKA. Our experience suggests single bicortical 5-mm pins placed in the femoral shaft have the added risk of creating a stress riser leading to the potential for fracture. Females may have a higher risk for this complication. We believe bicortical pin fixation in the femur or tibia no longer is indicated.

Patient Specific Guides in Total Knee Arthroplasty-Are They Accurate in Restoring Mechanical Alignment? A Prospective Clinical Series of 175 Cases

“…CAN also comes at the expense of increased patient co-morbidities, such as tourniquet and operating time, increased instrument trays and bulky navigation equipment, and intra-operative complications. Several studies have shown fractures associated with the insertion of CAN guide pins [12][13][14] . Navigation has been shown to increase surgical operating time, with a meta-analysis demonstrated a mean increase of 23% in time [9] .…”

“…In addition, computer-navigated surgery has been shown to have increased tourniquet and operative time [9][10][11] . There have also been reports of femoral and tibial fractures from navigation pin sites [12][13][14] .…”

Navigation-Assisted Total Knee Arthroplasty for the Knee Retaining Femoral Intramedullary Nail, and Distal Femoral Plate and Screws

“…Two anchoring pins were inserted for the femur but three pins can be inserted for more secure fixation. Some cases with an anecdotal fractures have been reported after the placement of navigation tracker pins 9,10). There are a few reports that a smaller size and unicortical fixation pin is safer.…”

“…Some cases with an anecdotal fractures have been reported after the placement of navigation tracker pins. 9 , 10) There are a few reports that a smaller size and unicortical fixation pin is safer. In one anatomic study, the findings indicated the close proximity of the popliteal vessel to potential injury with the bicortical placement of tracker pins in the anteroposterior direction in a typical total knee approach.…”

Navigation in Total Knee Arthroplasty

“…Even though some authors, such as Stiehl et al (15) , have demonstrated the possibility of reducing the duration of the operation, most authors have reported that the duration of the operation increases by around 10 to 15 minutes. There have also been some reports of cases of fracture at the pin fixation sites in the tibia and femur 16 , 17 , 18 , 19 . However, these are isolated reports, and there is no evidence that the incidence of periprosthetic fractures is greater than in non-navigated arthroplasty.…”