Management and results in periprosthetic tibial fracture after total knee arthroplasty: Two-center 15-case retrospective series at 2 years’ follow-up

Bauer, Camille; Zaharia, Bogdan; Galliot, Florent; Parot, Jauffrey; Houfani, Fayçal; Mayer, Julien; Mainard, Didier

doi:10.1016/j.otsr.2020.01.008

Cited by 11 publications

(4 citation statements)

References 35 publications

(63 reference statements)

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“…Bauer et al 12 reported on a case series of 15 periprosthetic tibial shaft fractures. Of the 15 patients, 2 had IMNs placed, and they did not report their nailing technique.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Diaphyseal Tibial Fractures Distal to a Total Knee Arthroplasty by Intramedullary Nailing Is Safe and Effective

Shaath

Avilcuea

Kerr

et al. 2022

Journal of Orthopaedic Trauma

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Objectives: To report the clinical result of a series of patients who underwent intramedullary nailing (IMN) of tibial shaft fractures distal to a total knee arthroplasty (TKA).Design: Retrospective case series.Setting: Level-1 trauma center.Patients/Participants: Patients who sustained a tibial shaft fracture distal to a TKA treated with an IMN.Intervention: IMN of tibial shaft fractures distal to a TKA. Main Outcome Measurements:Postoperative weight-bearing status, readmissions, and complications or failure of treatment within 90 days; Knee Injury and Osteoarthritis Outcome Scores at the final follow-up; failure of treatment; and revision surgery.Results: Nine patients were included. The average age was 71.4 years (range 55-87 years). All TKAs were cemented. The average distance between the tibial keel and the cortical density of the tibial tubercle was 24.1 mm (range 19.5-26.7 mm). Six nails were inserted using an infrapatellar portal, 2 were inserted using a suprapatellar portal, and 1 was inserted using a lateral parapatellar approach. The median nail diameter was 10 mm (range 9-12 mm). All fractures were healed at the final follow-up. There were no infections or arthroplasty-related complications. Knee Injury and Osteoarthritis Outcome Scores ranged from 100% to 74% (median 82%). Conclusion:Overall, we report on the largest cohort in the literature undergoing IMN of a tibial shaft fracture distal to a TKA. We demonstrate that IMN of diaphyseal tibial fractures distal to a TKA can be performed safely. We additionally demonstrate that this treatment is highly effective in achieving fracture union with no arthroplasty-related complications.

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“…Bauer et al 12 reported on a case series of 15 periprosthetic tibial shaft fractures. Of the 15 patients, 2 had IMNs placed, and they did not report their nailing technique.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Diaphyseal Tibial Fractures Distal to a Total Knee Arthroplasty by Intramedullary Nailing Is Safe and Effective

Shaath

Avilcuea

Kerr

et al. 2022

Journal of Orthopaedic Trauma

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“…A revision surgery is bound to encounter various obstacles in comparison with primary prosthesis replacement surgery, whether it involves hip, knee or shoulder: extensive osteolysis or even fracture often exists around the prosthesis, failed prostheses are sometimes difficult to remove, and the poor quality of the residual bone also significantly threatens the holistic stability [ [16] , [17] , [18] , [19] ]. These complexities all pose severe challenges to the field of hip joint revision.…”

Section: Discussionmentioning

confidence: 99%

A novel revision system for complex pelvic defects utilizing 3D-printed custom prosthesis

Hao

Luo

et al. 2021

Journal of Orthopaedic Translation

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Background Thus far, the hip revision surgery has been widely used and promoted, and the technology has been constantly innovated, such as tissue engineering, 3D printing prosthesis, etc. However, traditional standardized prosthesis, allograft, autograft, bone cement and reinforcing ring are still the main treatment methods in the mainstream pelvic defects classification systems for hip revision. In addition, the mainstream classification systems are still mainly focus on the peri-acetabulum, but less on the large-scale complex pelvic defects that widely affecting the regions far away from the acetabulum, which also have a significant impact on the holistic biomechanical properties of pelvis. Methods After integrating the design experience of custom prostheses and the understanding of biomechanical properties of pelvis, an innovative pelvic defects classification for custom revision was preliminarily proposed, and was practiced in surgeries. Some typical cases were chosen for elucidation in this study, and two observers each evaluated their CT data independently twice. Intraobserver and interobserver agreement were calculated using the kappa statistic to evaluate the reliability. The pelvis defects were classified into five types and two subtypes. The corresponding reconstruction principles, as the main basis to support the classification, were also described in detail. Prosthesis position examination and Harris hip score were utilized to evaluate the clinical outcome. Results The installed prostheses resulted in high concordance with preoperative position planning, significantly improved Harris score, low postoperative complication rate and no re-revision case. In addition, The interobserver and intraobserver agreement were both excellent. Conclusion The presenting revision system for complex pelvic defects utilizing 3D-printed custom prosthesis and corresponding classification of pelvic defects can preliminarily guide patients’ grouping and prosthesis design, and may potentially provide an innovative, feasible, and efficient basis for complex total hip arthroplasty (THA) revision. Translational potential statement This study provides a novel method for prosthetic revision of peri-acetabular pelvic defects, and is expected to systematically improve the efficiency of prosthesis design and surgery in clinical practice.

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“…A study of periprosthetic tibial fractures found that Felix I fractures are associated with a higher risk of postoperative non-surgical complications, and that those treated with a proximal tibia replacement may cause the development of periprosthetic joint infections [ 24 ]. Bauer et al emphasize that while functional results are good, periprosthetic tibial fractures demonstrated high complication and revision rates [ 25 ]. Their analysis, based on the French Society of Orthopedic Surgery and Traumatology (SoFCOT) classification [ 26 ], concluded that type B (fracture contact with keel or stem) has an especially poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation

Grzelecki

Marczak

Kwolek

et al. 2021

JCM

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The aim of this study was to evaluate the bone union, complication rate, clinical and functional outcomes of long-stemmed total knee arthroplasty (TKA) in patients with periprosthetic femoral or tibial shaft fractures and in patients with femoral or tibial shaft fractures with coexisting advanced knee osteoarthritis (OA). This retrospective study comprised 25 patients who underwent surgery due to tibial or femoral shaft fractures: (1) with coexisting severe knee OA or (2) with a periprosthetic fracture requiring implant exchange. In all cases, fracture stabilization was performed intramedullary with the use of long-stemmed implants without the use of additional fixation material (plates, screws, or cerclage). Bone union was achieved in 22/25 patients (88%). One patient required revision with additional plate stabilization due to non-union, and asymptomatic partial bone union was observed in two cases. The group with periprosthetic fractures demonstrated good clinical (mean 73.1 ± 13.3) and moderate functional (mean 59.2 ± 18.8) outcomes in the Knee Society Scoring system (KSS). In the group with shaft fracture and coexisting OA significantly higher clinical (excellent results, mean 84.1 ± 11; p = 0.03) and functional (good results, mean 76.2 ± 20.6; p = 0.04) results were noted. There were no statistically significant differences in terms of range of motion (ROM) or complication rate between these two groups. One-stage TKA with a long-stemmed implant without the use of additional fixation material is an effective method for the treatment of femoral or tibial shaft fractures in patients who require joint replacement. Despite being technically demanding, the approach yields bone union and moderate to excellent clinical and functional outcomes with a relatively low complication rate.

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Management and results in periprosthetic tibial fracture after total knee arthroplasty: Two-center 15-case retrospective series at 2 years’ follow-up

Cited by 11 publications

References 35 publications

Treatment of Diaphyseal Tibial Fractures Distal to a Total Knee Arthroplasty by Intramedullary Nailing Is Safe and Effective

Treatment of Diaphyseal Tibial Fractures Distal to a Total Knee Arthroplasty by Intramedullary Nailing Is Safe and Effective

A novel revision system for complex pelvic defects utilizing 3D-printed custom prosthesis

Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation

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