A Unique Pattern of Peri-Prosthetic Fracture Following Total Knee Arthroplasty: The Insufficiency Fracture

Shahi, Alisina; Saleh, Usama Hassan; Tan, Timothy L.; Elfekky, Mohamed; Tarabichi, Samih

doi:10.1016/j.arth.2015.01.006

Cited by 10 publications

(25 citation statements)

References 22 publications

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“…Previous reports have found the unloaded condyle in a patient with a varus or valgus preoperative deformity combined with osteoporosis to be at risk for developing early insufficiency fractures [12,13]. The unloaded femoral condyle, as evidenced in our cases and 2 prior case series [12,13], appears to be at risk because of decreased focal BMD. Ishii et al [14] found on 116 consecutive osteoarthritic patients that the BMD of the medial femoral condyle had 30% greater density than the lateral femoral condyle.…”

Section: Discussionsupporting

confidence: 55%

“…We were surprised to find that this implant system had the lowest box resection volume of all the designs in the study by Graceffa et al [23]. However, insufficiency fractures have occurred when no box resection was performed because the largest case series of insufficiency fractures, comprising 15 cases (over half of all reported cases), involved cruciate-retaining implants only [12]. In addition to the reduced bone stock after femoral box resection, our patients had small component sizes.…”

Section: Discussionmentioning

confidence: 70%

“…Allowing the femoral condyle to unite before implant removal could prevent iatrogenic worsening of the femur fracture during implant removal. Shahi et al [12] pointed out the challenge in revising implants in the osteoporotic bone of such patients, noting the regular need to use metaphyseal cone fixation to account for bone loss that occurred when removing the implant components. Both of those case series included at least one severe fracture presentation where a rotating hinge or distal femoral replacement was necessary.…”

Section: Discussionmentioning

confidence: 99%

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Sister, Sister! Siblings With Simultaneous Early Femoral Insufficiency Fractures After Total Knee Arthroplasty

et al. 2021

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Early periprosthetic fractures after total knee arthroplasty are rare but devastating complications which require revision surgery and lead to poor patient satisfaction. We present 2 siblings who underwent primary total knee arthroplasty on the same day and then both presented 2 weeks after surgery with atraumatic periprosthetic femur fractures. The first patient underwent revision for a cemented distal femoral replacement with stemmed tibial fixation. The second patient underwent an isolated femoral component revision with a stemmed femoral component and distal augment. Histological evaluation identified significant peri-implant osteoporosis. The variation in complexity associated with early periprosthetic femoral insufficiency fractures is highlighted by these 2 cases. Surgeons may consider using stemmed femoral components in similar patients if poor distal femoral bone stock is encountered intraoperatively.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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Sister, Sister! Siblings With Simultaneous Early Femoral Insufficiency Fractures After Total Knee Arthroplasty

et al. 2021

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“…Shahi et al. published their findings of isolated periprosthetic compression factors following TKA [29] . They performed a retrospective review and identified 14 patients, all of whom sustained compression fractures of the lateral femoral condyle.…”

Section: Discussionmentioning

confidence: 99%

Early femoral condyle insufficiency fractures after total knee arthroplasty: treatment with delayed surgery and femoral component revision

2018

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BackgroundPeriprosthetic fracture following total knee arthroplasty (TKA) is usually associated with a traumatic event and typically treated with fracture fixation techniques. However, we report on a series of patients with early atraumatic condyle fractures that occurred as a result of insufficiency of the unloaded preoperative femoral condyle treated with delayed reconstruction.MethodsWe retrospectively reviewed a series of 7 patients who sustained femoral condyle fractures following TKA and evaluated risk factors for insufficiency.ResultsThere were 6 females and 1 male with an average age of 65.5 (range, 63-75) years and an average body mass index of 29.4 (range, 27-32). Fracture occurred on average 24.9 days from the index surgery and secondary to a low energy mechanism. Five patients had valgus alignment (mean, 15.2°) preoperatively and sustained fracture of the unloaded medial femoral condyle. Two patients had varus alignment (mean, 7.0°) preoperatively and both fractured the unloaded lateral condyle. One patient underwent early intervention requiring distal femoral replacement secondary to femoral bone loss. The remaining 6 patients underwent delayed surgery for an average of 6 weeks to allow for fracture healing followed by femoral component revision. At last follow-up (average, 48.5 months), 1 patient required a tibial component revision; however, no revision of the femoral component was required.ConclusionsEarly femoral condyle insufficiency fractures following TKA may be a risk in females with poor bone quality and preoperative valgus alignment. Delayed surgery and femoral component revision is a treatment strategy that prevented the need for other tertiary reconstruction.

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“…Isolated femoral condyle insufficiency fractures status after primary TKA were first described by Shahi et al [ 23 ], reporting on a series of 15 patients. The TKAs were all performed using CR bearings.…”

Section: Discussionmentioning

confidence: 99%

Femoral Condyle Insufficiency Fracture After Total Knee Arthroplasty Using a Stemless Femoral Component With a Midlevel Constraint Articular Surface

et al. 2022

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Midlevel constraint prostheses have provided increased varus/valgus and rotational stability for patients with severe deformity or ligamentous instability undergoing total knee arthroplasty (TKA). Here we present a series of 5 patients, 2 in detail, who underwent a primary TKA with a midlevel constraint articular surface and a primary femoral component without stem extension who all suffered isolated medial femoral condyle insufficiency fractures. All 5 TKAs were performed in females with both preoperative valgus deformity and flexion contractures. Patients had an average age of 74.4 years, height 62.4 in, and weight 156.2 lbs. Revision TKA was performed in 4 of 5 cases. As a result of these cases, we now routinely consider implanting a stemmed femoral component in this population with osteoporotic medial femoral condyles.

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A Unique Pattern of Peri-Prosthetic Fracture Following Total Knee Arthroplasty: The Insufficiency Fracture

Cited by 10 publications

References 22 publications

Sister, Sister! Siblings With Simultaneous Early Femoral Insufficiency Fractures After Total Knee Arthroplasty

Sister, Sister! Siblings With Simultaneous Early Femoral Insufficiency Fractures After Total Knee Arthroplasty

Early femoral condyle insufficiency fractures after total knee arthroplasty: treatment with delayed surgery and femoral component revision

Femoral Condyle Insufficiency Fracture After Total Knee Arthroplasty Using a Stemless Femoral Component With a Midlevel Constraint Articular Surface

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