Adverse Events in the Treatment of Periprosthetic Fractures Around the Knee – a Clinical and Radiological Outcome Analysis

Abstract

PpFxK are severe injuries and are associated with a high rate of adverse events related to treatment. Patients often have a complex background and a history of revision surgery or periprosthetic joint infection. The treatment of PpFxK should therefore take place at a centre with expertise in traumatology as well as in revision arthroplasty. Preoperative infection diagnostic testing as well as adequate imaging (X-rays and CT) are essential. We furthermore advise early evaluation of revision arthroplasty, especially in elderly patients suffering from PpFxK with insufficient bone quality around the TKA and closeness between fracture and TKA. In the case of plate fixation, it is important to give attention to correct reduction - to prevent non-union, loosening of the implant and failure of the osteosynthesis - as well as to consider double plating.

Periprosthetic fractures of hip and knee–A morbidity and mortality analysis

“…Our 44.4% overall complication rate following surgery for periprosthetic knee fractures is comparable to the 44% reported by Schreiner et al in a study including 50 patients with TKA-PPF[27] . On the other hand, our overall complication rate of 29.9% following surgery for PPF of the hip is lower than the 46.9% reported by Laurer et al, in a cohort of 32 patients undergoing surgery for periprosthetic hip fractures[22] .In our cohort, a surgical delay of ≥ 2 days was neither in the univariate nor multivariate setting significantly associated with an increased risk for postoperative complications, which is contradictory to the results observed byGriffiths et al in a study in 60 patients with Vancouver type B and C fractures, where a surgical delay of ≥ 3 days significantly increased the complication rate [14] .…”

Periprosthetic patella fractures in total knee replacement and revision surgeries: how to diagnose and treat this rare but potentially devastating complication—a review of the current literature

“…Currently, no PPPFs classification system is universally validated; the most widely used are those of Goldberg et al [6] and Ortiguera and Berry [1]. The pathogenesis is multifactorial, and many different predisposing risk factors are reported in the literature [3,4,[7][8][9]. Most fractures are not associated with direct trauma but are discovered during follow-up [4].…”

Locking plate fixation of distal periprosthetic femoral fractures

“…Aufgrund der immer höheren Lebenserwartung und des steigenden Aktivitätsniveaus im Alter ist mit einem weiteren Anstieg der Implantationen zu rechnen [ 9 ]. Verbunden damit werden auch Komplikationen wie Infektionen/Wundheilungsstörungen, Prothesenlockerungen, Luxationen und periprothetische Frakturen zunehmen [ 26 ]. Vor allem die prothesennahen Frakturen stellen eine große Herausforderung in der Orthopädie und Unfallchirurgie dar.…”

“…Aufgrund des hohen Patientenalters bestehen neben der Osteoporose oft zahlreiche weitere Komorbiditäten. Weitere Risikofaktoren, eine periprothetische Femurfraktur zu erleiden, sind bereits stattgehabte operative Revisionen, Infektionen, Achsfehler und Malalignment der Prothesenkomponenten, chronische Prothesenlockerung sowie internistische und neurologische Begleitumstände, die das Sturzrisiko von Patienten erhöhen [ 26 ]. Begleiterkrankungen begünstigen jedoch nicht nur das Auftreten von Frakturen, sondern erhöhen ebenfalls das intra- und postoperative Risiko [ 32 ].…”