Kniegelenksnahe Frakturen bei Knie-TEP

Frosch, Karl‐Heinz; Madert, J.

doi:10.1055/s-0035-1545838

Cited by 5 publications

(5 citation statements)

References 28 publications

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“…Periprothetische Frakturen am Kniegelenk stellen eine schwere Verletzung dar, deren Therapie von hohen Komplikationsraten begleitet ist [1]. Bei steigenden Implantationszahlen in der Endoprothetik sowie einem älter und komplexer werdenden Patientengut ist generell bzw.…”

Section: Resultsunclassified

“…Das Kollektiv unserer retrospektiven Studie mit klinisch-radiologischen Ergebnissen nach operativer Versorgung periprothetischer Frakturen bei einliegender KTP umfasst das gesamte Frakturspektrum, ist quantitativ jedoch durch die Rorabeck-II-Frakturen geprägt. Diese Verteilung entspricht bisherigen Literaturdaten [1,26,27]. Am zweithäufigsten traten PpFx nach Felix auf.…”

Section: Diskussionunclassified

“…Da die bisherige Literatur jedoch vor allem aus Reviews besteht, die sich auf ältere Originalarbeiten beziehen, sind unsere Daten sicherlich auch zukünftig als realistisch für den klinischen Alltag zu werten und für die generelle Versorgung eines zunehmend komplexer werdenden Patientengutes zu antizipieren. Prospektiv randomisierte Studien zum Thema PpFxK generell und insbesondere offenes vs. minimalinvasives Vorgehen sind aktuell nicht vorhanden und auch zur Thematik der Cerclagen-Versorgung liegen wenig Daten vor [1]. Nach Ruchholtz et al besteht die Empfehlung zur Anwendung weniger invasiver Prozeduren [23].…”

Section: Diskussionunclassified

“…Nach Revisionseingriffen kommen PpFxK mit einer Häufigkeit von bis zu 30 % vor [5,8] bzw. knapp 40 % der PpFxK treten bei vorhandenen Revisionsprothesen auf [1,9,10]. Am häufigsten ist das distale Femur im suprakondylären Bereich betroffen (ca.…”

Section: Introductionunclassified

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

et al. 2018

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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.

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Section: Resultsunclassified

Section: Diskussionunclassified

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

et al. 2018

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“…The overall incidence of periprosthetic fractures after TKA is estimated to range between 0.3 to 2.5% [ 2 – 4 ]. The vast majority involves the distal femur (2%) whereas the proximal tibia is less frequently affected (0.3–0.5%) and thus has received little attention in the past [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Periprosthetic tibial fractures in total knee arthroplasty – an outcome analysis of a challenging and underreported surgical issue

Schreiner

Schmidutz

Ateschrang

et al. 2018

BMC Musculoskelet Disord

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BackgroundPeriprosthetic fractures after total knee arthroplasty (TKA) are an increasing problem and challenging to treat. The tibial side is commonly less affected than the femoral side wherefore few studies and case reports are available. The aim of this study was to analyze the outcome of periprosthetic tibial fractures and compare our data with current literature.MethodsAll periprosthetic tibial TKA fractures that were treated at our Level 1 Trauma Center between 2011 and 2015 were included and analyzed consecutively. The Felix classification was used to assess the fracture type and evaluation included the radiological and clinical outcome (Knee Society Score/KSS, Oxford Knee Score/OKS).ResultsFrom a total of 50 periprosthetic TKA fractures, 9 cases (7 female, 2 male; 2 cruciate retaining, 7 constrained TKAs) involving the tibial side were identified. The mean age in this group was 77 (65–85) years with a follow-up rate of 67% after a mean of 22 (0–36) months. The Felix classification showed type IB (n = 1), type IIB (n = 2), type IIIA (n = 4) and type IIIB (n = 2) and surgical intervention included ORIF (n = 6), revision arthroplasty (n = 1), arthrodesis (n = 1) and amputation (n = 1). The rate of adverse events and revision was 55.6% including impaired wound healing, infection and re-fracture respectively peri-implant fracture. Main revision surgery included soft tissue surgery, arthrodesis, amputation and re-osteosynthesis. The clinical outcome showed a mean OKS of 29 (19–39) points and a functional/knee KSS of 53 (40–70)/41 (17–72) points. Radiological analyses showed 4 cases of malalignment after reduction and plate fixation.ConclusionsPeriprosthetic tibial fractures predominantly affect elderly patients with a reduced bone quality and reveal a high complication rate. Careful operative planning with individual solutions respecting the individual patient condition is crucial. If ORIF with a plate is considered, restoration of the correct alignment and careful soft tissue management including minimal invasive procedures seem important factors for the postoperative outcome.

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