Periprosthetic Fractures after Total Knee Arthroplasty

Abstract

Purpose. To evaluate outcome in 20 patients treated for periprosthetic fractures after total knee arthroplasty (TKA). Methods. Records of 14 women and 6 men aged 45 to 85 (mean, 67) years who underwent operative (n=18) or conservative (n=2) treatment for periprosthetic fractures of the supracondylar femur (n=15), patella (n=3), and tibia (n=2) following minor falls (n=18) or high-velocity injury (n=2) were reviewed. The mean time from TKA to fracture was 43 (range, 14-98) months. Of the 15 supracondylar femoral fractures, 2 were managed with immobilisation in a long leg cast, 11 with internal fixation using locked compression plating, and 2 with revision arthroplasty. All 3 patellar fractures were managed with tension band wiring. Both tibial fractures were managed with revision arthroplasty. Radiographic and functional outcomes (the Knee Society scores) were assessed. 15 (range, 12-38) weeks. One patient had delayed union. Postoperative alignment was satisfactory in all patients except one (with 5º varus). The mean tibiofemoral angle was 4º valgus. The mean range of motion was 98.5º. The mean Knee Society knee score was 85 (range, 75-89) and the functional score was 76 (range, 70-85). No patient had implant failure, loss of reduction, deep infection, deep vein thrombosis, or pulmonary embolism. Conclusion. The locked compression plate is effective in managing periprosthetic femoral fractures. Periprosthetic patellar and tibial fractures are uncommon. The latter often warrant revision arthroplasty owing to the loose implant.

Periprosthetic fractures of the knee: a comprehensive review

“…Of those, 67% were treated non-operatively with observation or cast application, of which all reported positive results. The purpose of a study written by Agarwal et al [40] was to evaluate the outcome in patients treated for periprosthetic fractures. Out of 15 patients with supracondylar femoral fractures, 2 were Roraback and Lewis Type I (non-displaced, with intact prosthesis-bone interface).…”

Ilizarov external fixation for a periprosthetic tibial fracture in severe osteoporosis: a case report

“…Treatment options for periprosthetic tibial fractures include using a knee immobilizer, traction, casting, open reduction and internal fixation with a plate-and-screw construct, revision arthroplasty, and amputation [14][15][16][17][18]. In the present case, the decision to place an Ilizarov external thin-wire fixator as minimally invasive surgery was made due to the patient's severe heart failure and renal failure.…”

Periprosthetic Femoral Fracture

“…The time from surgical treatment with lower extremity arthroplasty until the occurrence of a corresponding PPFF is reported as 20-63.6 months in the literature (5,11,13,14). Mortality after PPFF and its treatment varies with patient age and concomitant diseases between 4.5% and 22% (13,(15)(16)(17)(18)(19).…”