Is the fracture pattern in periprosthetic fractures around the knee related with the anterior femoral notch?

Abstract

Introduction: Periprosthetic fractures around the knee (PPF) are a devastating complication of total knee arthroplasty (TKA). Anterior femoral notching during TKA is considered a risk factor for PPF. The aim of this paper is to determine if an anterior femoral notch after total knee arthroplasty may affect the fracture pattern when a PPF appears postoperatively. Material and methods: 50 patients diagnosed in our centre of a PPF from January 2010 to December 2013 were retrospectively enrolled. 100 patients who underwent a total knee arthroplasty without fracture were randomly obtained as a control group. Evidence of the notch was searched in both groups in postoperative X-rays. In the PPF group, distance from the shield of the femoral component to the most distal (d) and proximal (D) point of the fracture were measured. Results: Two different groups were obtained: 1) d = 0 (33 out of 50 patients); the fracture is supposed to be related with the notch as it's a theoretically weaker area. 2) d > 0 (17 out of 50 patients); the fracture pattern has no relationship with the notch. Prevalence of patients suffering a fracture in the shield of the prosthesis (d = 0), was similar in both patients with notch (66,7%) and without it (68%). Conclusions: In conclusion, fracture pattern is not related with the existence of a femoral notch in the clinical setting.

Periprosthetic fractures of the knee: a comprehensive review

“…Another important, yet controversial, factor to discuss is femoral notching. After reviewing the literature pertaining to the subject, the prevalence of anterior cortex notching of the femur is estimated at 3.5-41% [14][15][16]. A previous study reviewed the biochemical analysis of fresh-frozen cadaveric femora.…”

“…Furthermore, it presented an 18% decrease in bending strength, and a mean reduction by 39.2% in torsional strength of the anterior femoral cortex [17]. However, when reviewing three papers written by Ritter [14], Minarro et al [15], and Gujarathi et al [16], results were contradictory. Ritter et al and Gujarathi et al analyzed the incidence of femoral notching and the presence of supracondylar femoral fractures, with a long follow-up period between 5 and 9 years.…”

“…Both authors concluded that there is no relationship between minimal anterior femoral notching and supracondylar fracture of the femur. Minarro et al [15] studied the fracture pattern relation with the anterior femoral notching. The author concluded that the fracture pattern is not related to the existence of a femoral notch in the clinical setting.…”

Effectiveness of circular external fixator in periprosthetic fractures around the knee

“…Periprosthetic fractures often result from minor trauma [1], which may be due to inappropriate placement of the components during surgical procedures (i.e. femoral notch), sex-related differences, osteoporosis, rheumatoid arthritis, neurological diseases, steroid use, or stress shielding [3,4]. In many elderly patients with periprosthetic fractures, the bone strength is lowered due to the deterioration of bone quality and a decrease in bone quantity; rigid fixation of the fracture is also difficult [5].…”

Effectiveness of circular external fixator in periprosthetic fractures around the knee

“…Periprosthetic fractures often result from minor trauma [1], which may be due to inappropriate placement of the components during surgical procedures (i.e. femoral notch), sex-related differences, osteoporosis, rheumatoid arthritis, neurological diseases, steroid use, or stress shielding [3,4]. In many elderly patients with periprosthetic fractures, the bone strength is lowered due to the deterioration of bone quality and a decrease in bone quantity; rigid fixation of the fracture is also difficult [5].…”