The Consequences of Anterior Femoral Notching in Total Knee Arthroplasty

Lesh, Mark L.; Schneider, David J.; Deol, Gurvinder S.; Davis, Barclay R.; Jacobs, Christopher R.; Pellegrini, Vincent D.

doi:10.2106/00004623-200008000-00005

Cited by 175 publications

(81 citation statements)

References 6 publications

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“…If a femoral component is placed in an overly flexed position, it can cause limited extension or polyethylene post wear resulting from impingement between the anterior part of the polyethylene insert and the anterior margin of the intercondylar box in TKA using a post-cam mechanism [23,25,28,38]. When a surgeon places a femoral component in an overly extended position relative to the femur, he or she may create a notch in the anterior femoral cortex, and some fear these notches may increase the prospective risk of a supracondylar fracture [19,25,29,31]. Few studies have explored the clinical implications of femoral component rotation in the sagittal plane.…”

Section: Introductionmentioning

confidence: 99%

Differences between Sagittal Femoral Mechanical and Distal Reference Axes Should Be Considered in Navigated TKA

Chung

Kang

Chang

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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In computer-assisted TKA, surgeons determine positioning of the femoral component in the sagittal plane based on the sagittal mechanical axis identified by the navigation system. We hypothesized mechanical and distal femoral axes may differ on lateral views and these variations are influenced by anteroposterior bowing and length of the femur. We measured angles between the mechanical axis and distal femoral axis on 200 true lateral radiographs of the whole femur from 100 adults. We used multivariate linear regression to identify predictors of differences between the axes. Depending on the method used to define the two axes, the mean angular difference between the axes was as much as 3.8°and as little as 0.0°, with standard differences ranging from 1.7°to 1.9°. Variation between the two axes increased with increased femoral bowing and increased femoral length. Surgeons should consider differences between the mechanical axes and distal femoral axes when they set the sagittal plane position of a femoral component in navigated cases. Our findings also may be relevant when measuring rotation of the femoral component in the sagittal plane from postoperative radiographs or when interpreting femoral component sagittal rotation results reported in other studies.

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Section: Introductionmentioning

confidence: 99%

Differences between Sagittal Femoral Mechanical and Distal Reference Axes Should Be Considered in Navigated TKA

Chung

Kang

Chang

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…Whilst most would agree that osteoporosis increases the risk of periprosthetic fractures, the role of notching the anterior femoral cortex remains controversial. Biomechanical studies appear to show a lesser load to failure with notching [12,14], but a recent large study suggests that it Fig. 4 Radiograph illustrating a retrograde nail in the presence of preexisting metalwork may not be as important clinically as previously suspected [20].…”

Section: Discussionmentioning

confidence: 99%

Supracondylar periprosthetic femoral fractures following total knee arthroplasty: treatment with a retrograde intramedullary nail

Chettiar

Jackson

Brewin

et al. 2008

International Orthopaedics (SICOT)

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Total knee replacement surgery is occasionally complicated by a supracondylar periprosthetic fracture, and this presents a challenging problem in an often frail population. Multiple nonoperative and operative treatments have been described which have the aim of restoring the patient to their pre-injury status. This study retrospectively reviews the results of the largest series to date of 14 such fractures treated by retrograde intramedullary supracondylar nailing and is supportive of its continued use with good functional outcomes, low complication rates, and 100% fracture union.Résumé Les prothèses totales du genou peuvent être occasionnellement compliquées par une fracture supra condylienne. De nombreuses méthodes thérapeutiques ont été décrites avec le but de restaurer l'état des patients avant la fracture. Une étude rétrospective sur une très large série de 14 fractures traitées par clous intramédullaires rétro-grades ont permis de mettre en évidence un devenir fonctionnel et un taux de complications très bas ainsi qu'un taux de consolidation de 100%.

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“…Shawen, et al, using 13 matched pairs of cadaver femora, demonstrated that a 3mm anterior cortical defect (ie-"notching") significantly decreased torsional load to failure and further demonstrated that fracture risk is increased in osteoporotic, notched femora [11]. In another cadaveric biomechanical study, Lesh et al showed that full-thickness notching of the anterior cortex significantly lessened the load to failure by decreasing the bending strength by 18% and torsional strength by about 40% [16]. Interestingly, clinical outcomes that validate these theoretical laboratory findings are lacking and several series have not correlated anterior femoral notching to an increased incidence of subsequent PDFF [17,18].…”

Section: Epidemiologymentioning

confidence: 99%

Periprosthetic Distal Femur Fractures: Review of Current Treatment Options

Head

2018

ReconRev

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The geriatric population in general and specifically recipients of total knee arthroplasty (TKA) have increasing functional demands along with an increasing life expectancy. Certain intraoperative aspects of the index procedure, revision TKA, or the patient's physiology (i.e.-osteoporosis, rheumatoid arthritis, neurologic disease) predispose the patient to post-operative periprosthetic distal femur fractures (PDFF). This review describes the epidemiology, classification, examination, and treatment options of PDFF. Osteoporosis and intraoperative anterior femoral cortex notching are primary patient and surgeon specific factors, respectively. The two most commonly used classification systems were described by Rorabeck and Kim and should be used to guide the surgeon's choice of treatment. The non-operative treatment of PDFF is rare, requires close radiographic follow up, and delayed union is common. Open reduction with internal fixation (ORIF) is best accomplished with minimally invasive techniques and distal locking screws. Retrograde, intra-medullary nail fixation is technically difficult, but provides earlier weight bearing and comparable time to union as ORIF. Revision TKA is indicated in patients with adequate bone stock, a simple fracture pattern without ligamentous instability, and a loose or malaligned femoral component. Allograftprosthetic composite (APC) or distal femoral replacement (DFR) is indicated for patients presenting with a PDFF about poor or deficient bone stock. Patients with PDFF present a challenge to the arthroplasty surgeon in regards to choice of treatment and increased morbidity and mortality post-operatively. Close follow up is required and fracture union is often delayed.

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The Consequences of Anterior Femoral Notching in Total Knee Arthroplasty

Cited by 175 publications

References 6 publications

Differences between Sagittal Femoral Mechanical and Distal Reference Axes Should Be Considered in Navigated TKA

Differences between Sagittal Femoral Mechanical and Distal Reference Axes Should Be Considered in Navigated TKA

Supracondylar periprosthetic femoral fractures following total knee arthroplasty: treatment with a retrograde intramedullary nail

Periprosthetic Distal Femur Fractures: Review of Current Treatment Options

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