Intraoperative Fractures of the Tibia and Femur in Knee Revision Surgery

Abstract

Intra-operative fractures in knee revision surgery are relatively rare and have not been well studied. They may occur during joint exposition, removal of the prosthesis or cement, or implantation of trial or original components. The fractures affect both the metaphyseal area and diaphysis of the tibia and femur. Tibial fractures are slightly more common than femur fractures. On the femur, the medial condyle is most frequently affected, followed by the femur diaphysis. The use of non-cemented stems is associated with a greater risk of intra-operative diaphyseal fractures than that of cemented stems. Overall, women and patients with an osteopenic bone structure have a higher risk of fractures. It is common that fractures are diagnosed post-operatively. In these cases, conservative therapy may be successful, depending on the stability of the prosthesis and bones. The most common surgical fixation options are cerclages and screws, followed by stem extensions for bridging the fracture. Plate fixation or use of strut grafts are also sensible therapy options. Overall, intraoperative fractures have a high healing potential with stable and good joint function. The revision rate is still 15%, which is most often caused by peri-prosthetic infection.

Editorial

“…Als Beispiel sei hier in 2023 die Arbeit der AG Geweberegeneration genannt mit "Empfehlungen zur Behandlung von Knorpelschäden am Kniegelenk" [1] und die 3 Arbeiten der Arbeitsgemeinschaft Endoprothetik zu tripolaren Pfannen in der Primärhüftendoprothetik [2], Glutealinsuffizienz nach Hüfttotalendoprothese [3] und intraoperativen Frakturen von Tibia und Femur in der Revisionssituation [4].…”