A cautionary case: osteoporotic femur fracture after robotic-assisted total knee arthroplasty

Skibicki, Hope E.; Ponzio, Danielle Y.; Brustein, Jason A.; Post, Zachary D.; Ong, Alvin; Orozco, Fabio

doi:10.1007/s00198-021-05977-5

Cited by 5 publications

(2 citation statements)

References 26 publications

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“…Additionally, the retrospective nature of this study introduces the potential for bias and confounding as subjects were not randomly allocated into each cohort. We adjusted for age, which could increase risk for pin-site fracture and statistically significantly differed between the two groups [15]. It is possible that other potential confounders existed.…”

Section: Discussionmentioning

confidence: 99%

A comparison of pin site complications between large and small pin diameters in robotic‐assisted total knee arthroplasty

et al. 2023

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Purpose Robotic-assisted total knee arthroplasty typically necessitates use of tracking pins, which can vary in diameter. Complications such as infections and fractures at the pin-site have been observed, but clarification of the effect of pin diameter on complication is needed. The aim of this study is to compare the pin-related complication rates following robotic-assisted total knee arthroplasty between 4.5 mm and 3.2 mm diameter pins. Methods In this retrospective cohort study, 90-day pin-site complication rates after robotic-assisted total knee arthroplasty were compared between 4.5 mm diameter and 3.2 mm diameter groups. In total, 367 patients were included: 177 with large pin diameter and 190 with small pin diameter. All four pin sites were evaluated using postoperative radiographs. Cases without orthogonal views or visualization of all four pin tracts were noted. Multivariate logistic regression was used to control for age, which differed between the two cohorts. Results The rate of pin-site complications was 5.6% in the large pin diameter cohort and 2.6% in the small pin diameter cohort, with no statistically significant difference between the groups. The adjusted odds ratio for complications in small compared to large diameter group was 0.48, with a p-value of 0.18. The most common pin-site complication was infection/persistent drainage, found in 1.9% of patients, followed by intraoperative fracture of the second cortex in 1.4%. Intraoperative fracture could not be ruled out in 96 cases due to inadequate radiographic visualization of all pin sites. There was one postoperative pin-site fracture in the large diameter cohort, which required operative fixation. Conclusion This study demonstrates no statistically significant difference in pin-site complication rates after robotic-assisted total knee arthroplasty between 4.5 mm and 3.2 mm pin diameter cohorts, although there was a trend towards increased intraoperative and postoperative pin-site fractures in the 4.5 mm group.

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Section: Discussionmentioning

confidence: 99%

A comparison of pin site complications between large and small pin diameters in robotic‐assisted total knee arthroplasty

et al. 2023

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“…It has been suggested that pin-site fractures are associated with obesity, osteoporosis, and poor drilling locations [7][8][9] . Our surgical team also encountered a case of femoral pin-site fracture in a femur that had been eccentrically drilled (i.e., resulting in a pin track that did not pass through the center of the bone).…”

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confidence: 99%

Biomechanical and Finite-Element Analysis of Femoral Pin-Site Fractures Following Navigation-Assisted Total Knee Arthroplasty

Sun

Zhang

Wang

et al. 2022

Journal of Bone and Joint Surgery

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Background:Femoral pin-site fracture is one of the most serious complications of navigation-assisted total knee arthroplasty (TKA). Its occurrence is associated with the loss of biomechanical strength caused by intraoperative femoral drilling. This study aimed to investigate the drilling location as a risk factor for pin-site fracture.Methods:A biomechanical analysis using rabbit femora was performed to determine the effects of drilling eccentricity and height. Torsional, 3-point bending, and axial compression tests were performed to evaluate biomechanical parameters, including failure strength, failure displacement, and stiffness. Fracture type and the presence of comminution were noted and analyzed. Finite-element analysis (FEA) was utilized to assess the stress distribution and deformation. The cumulative sum (CUSUM) method was applied to define the safe range for drilling eccentricity.Results:Drilling operations were accurately implemented. Biomechanical tests confirmed that severely eccentric drilling significantly reduced the biomechanical strength of the femur, especially in torsion. FEA results provided evidence of threatening stress concentration in severely eccentric drilling. The overall safe range of eccentricity relative to the center of the femur was found to be between 50% of the radius in the anterolateral direction and 70% of the radius in the posteromedial direction.Conclusions:Severely eccentric drilling significantly increased the risk of femoral pin-site fracture, especially under torsional stress. Femoral drilling should be performed in the safe zone that was identified.

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Fracture through tracking pin sites following a robotic-assisted total knee arthroplasty

et al. 2022

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A cautionary case: osteoporotic femur fracture after robotic-assisted total knee arthroplasty

Cited by 5 publications

References 26 publications

A comparison of pin site complications between large and small pin diameters in robotic‐assisted total knee arthroplasty

A comparison of pin site complications between large and small pin diameters in robotic‐assisted total knee arthroplasty

Biomechanical and Finite-Element Analysis of Femoral Pin-Site Fractures Following Navigation-Assisted Total Knee Arthroplasty

Fracture through tracking pin sites following a robotic-assisted total knee arthroplasty

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