Periprosthetic tibial fractures after cementless low contact stress total knee arthroplasty

Thompson, Neville; McAlinden, M. Gavan; Breslin, Elizabeth; Crone, M.; Kernohan, George; Beverland, David

doi:10.1054/arth.2001.25563

Cited by 31 publications

(13 citation statements)

References 17 publications

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“…Thompson et al described 7 tibial fractures (Felix type I) after changing from a cemented to a cementless TKA, which were successfully treated conservatively ( n = 3) or with a long cemented stem ( n = 4) [ 19 ]. Risk factors for the occurrence were a preoperative neutral or valgus knee axis and osteopenia whereas age, gender and diagnosis were not [ 19 ]. The authors underline the importance of tibial cement fixation and a correct alignment [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Periprosthetic tibial fractures in total knee arthroplasty – an outcome analysis of a challenging and underreported surgical issue

Schreiner

Schmidutz

Ateschrang

et al. 2018

BMC Musculoskelet Disord

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BackgroundPeriprosthetic fractures after total knee arthroplasty (TKA) are an increasing problem and challenging to treat. The tibial side is commonly less affected than the femoral side wherefore few studies and case reports are available. The aim of this study was to analyze the outcome of periprosthetic tibial fractures and compare our data with current literature.MethodsAll periprosthetic tibial TKA fractures that were treated at our Level 1 Trauma Center between 2011 and 2015 were included and analyzed consecutively. The Felix classification was used to assess the fracture type and evaluation included the radiological and clinical outcome (Knee Society Score/KSS, Oxford Knee Score/OKS).ResultsFrom a total of 50 periprosthetic TKA fractures, 9 cases (7 female, 2 male; 2 cruciate retaining, 7 constrained TKAs) involving the tibial side were identified. The mean age in this group was 77 (65–85) years with a follow-up rate of 67% after a mean of 22 (0–36) months. The Felix classification showed type IB (n = 1), type IIB (n = 2), type IIIA (n = 4) and type IIIB (n = 2) and surgical intervention included ORIF (n = 6), revision arthroplasty (n = 1), arthrodesis (n = 1) and amputation (n = 1). The rate of adverse events and revision was 55.6% including impaired wound healing, infection and re-fracture respectively peri-implant fracture. Main revision surgery included soft tissue surgery, arthrodesis, amputation and re-osteosynthesis. The clinical outcome showed a mean OKS of 29 (19–39) points and a functional/knee KSS of 53 (40–70)/41 (17–72) points. Radiological analyses showed 4 cases of malalignment after reduction and plate fixation.ConclusionsPeriprosthetic tibial fractures predominantly affect elderly patients with a reduced bone quality and reveal a high complication rate. Careful operative planning with individual solutions respecting the individual patient condition is crucial. If ORIF with a plate is considered, restoration of the correct alignment and careful soft tissue management including minimal invasive procedures seem important factors for the postoperative outcome.

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Section: Discussionmentioning

confidence: 99%

“…Risk factors for the occurrence were a preoperative neutral or valgus knee axis and osteopenia whereas age, gender and diagnosis were not [ 19 ]. The authors underline the importance of tibial cement fixation and a correct alignment [ 19 ]. The importance of correct tibial alignment is confirmed by Felix et al and our results.…”

Section: Discussionmentioning

confidence: 99%

Periprosthetic tibial fractures in total knee arthroplasty – an outcome analysis of a challenging and underreported surgical issue

Schreiner

Schmidutz

Ateschrang

et al. 2018

BMC Musculoskelet Disord

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“…Petersen et al (1995) have shown that a high preoperative tibial trabecular bone BMD leads to less continuous migration in cementless prostheses. Periprosthetic tibial fractures are most commonly depressions or split fractures involving the interface between the tibial tray and the bone (Thompson et al 2001). Felix et al (1997) found that 60% of periprosthetic tibial fractures were metaphyseal (type I), most often involving the medial condyle.…”

Section: Discussionmentioning

confidence: 99%

“…Although these fractures are rare, they occur without trauma, they cause varus collapse and distorted alignment, and are challenging to treat. According to Thompson et al (2001), knees initially in valgus or neutral alignment show a significantly increased risk of postoperative fracture. The authors encourage others to pay careful attention to these patients, especially when associated with low BMD, and to consider cementing the tibial implant to reduce fracture incidence (Thompson et al 2001).…”

Section: Discussionmentioning

confidence: 99%

Periprosthetic tibial bone mineral density changes after total knee arthroplastyOne-year follow-up study of 69 patients

Soininvaara

Miettinen

Jurvelin

et al. 2004

Acta Orthopaedica Scandinavica

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Background The critical structure supporting the prosthetic components in total knee arthroplasty (TKA) is tibial trabecular bone. The quality of tibial bone can be evaluated by bone mineral density (BMD) measurements.Patients and methods We prospectively measured changes in BMD in the proximal tibia after cemented TKA in osteoarthrotic knees. 69 patients were scanned by dual-energy X-ray absorptiometry (DXA) within a week after surgery, and after 3, 6 and 12 months.Results At baseline, the medial region of interest (ROI) BMD was higher in the varus knees than in the valgus aligned knees (p = 0.02). The medial metaphyseal ROI showed a decrease in BMD during the follow-up in preoperatively varus knee joints (p < 0.001). In preoperatively valgus knees, there was a slight increase in medial compartment BMD which was not significant (p = 0.2). Alignment correction in both groups showed bone remodeling giving similar medial and lateral BMD values, suggesting that the bone became equally strong in both compartments of the metaphysis. There was no association between increasing American Knee Society (AKS) scores and bone remodeling.Interpretation We suggest that this remodeling is caused by postoperative changes in tibial loading. Our results support the clinical importance of recreating proper valgus alignment of the knee joint in the TKA operation, thus possibly providing better conditions for longevity of the tibial component.

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“…Surgery was performed under the care of the senior author. The philosophy for alignment was to achieve a balanced knee through bone cuts rather than soft tissue releases, and not to aim for a neutral mechanical axis [ 29 , 30 ]. At the beginning of the study hybrid fixation with a cemented tibia was used in female patients with valgus deformities due to concern regarding early post-operative tibial insufficiency fractures [ 31 ].…”

Section: Methodsmentioning

confidence: 99%

A prospective evaluation of a largely cementless total knee arthroplasty cohort without patellar resurfacing: 10-year outcomes and survivorship

Napier

O’Neill

O’Brien

et al. 2018

BMC Musculoskelet Disord

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BackgroundThe theoretical benefits of a mobile bearing design in Total Knee Arthroplasty (TKA) include increased articular surface conformity with a reduction in both polyethylene wear and implant interface shear. However, to date these theoretical advantages have not been translated into published evidence of superior survivorship. This paper presents the results of a prospective, non-comparative study evaluating the performance of the mobile bearing Low Contact Stress LCS Complete Rotating Platform TKA in a largely cementless cohort without patellar resurfacing.Methods237 consecutive patients (240 knees) undergoing primary TKA were prospectively recruited. All received the LCS Complete Rotating Platform TKA (DePuy International, Leeds, UK). Clinical and radiographic assessments were performed at 3, 12, 60 and 120 months post-operatively. Radiographic evaluation was performed by an independent external surgeon.ResultsThe mean age was 70.3 years. 77.5% of cases were cementless. Radiographic assessment suggested excellent femoral component fixation. 22 tibial radiolucent lines (RLLs) > 1 mm were observed in 12 knees. No RLLs were progressive. There have been two revisions; one for late infection and one for aseptic loosening. No patients underwent secondary patellar resurfacing. The cumulative implant survivorship, using component revision for any reason as the endpoint, was 98.9% (95% CI, 95.6 to 99.7%) at 10 years.ConclusionsThe excellent survivorship at a minimum 10-year follow-up supports the use of uncemented porous coated fixation without patellar resurfacing with the non-posterior stabilized LCS Complete Rotating Platform TKA.

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Periprosthetic tibial fractures after cementless low contact stress total knee arthroplasty

Cited by 31 publications

References 17 publications

Periprosthetic tibial fractures in total knee arthroplasty – an outcome analysis of a challenging and underreported surgical issue

Periprosthetic tibial fractures in total knee arthroplasty – an outcome analysis of a challenging and underreported surgical issue

Periprosthetic tibial bone mineral density changes after total knee arthroplastyOne-year follow-up study of 69 patients

A prospective evaluation of a largely cementless total knee arthroplasty cohort without patellar resurfacing: 10-year outcomes and survivorship

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