Periprosthetic fractures around total knee arthroplasty

Abstract

Periprosthetic fractures around total knee replacements were first reported more than 30 years ago. They are becoming more common. Various associated risk factors have been described. Treatment options for femoral fractures around total knee replacements include non-operative management, locked plates, retrograde intramedullary nails and revision arthroplasty. Periprosthetic fractures of the tibia and patella are also described, but are less common. This review article provides an overview of the epidemiology and frequency of periprosthetic fractures around total knee replacement, their initial assessment and the current treatment options available.

Bilateral distal femoral fracture after total knee arthroplasty

“…The classic predisposing factors are osteopenia, infection and osteolysis, female gender, older age, anterior femoral notching, and revision arthroplasty 3 . However, Singh et al, 1 in a retrospective study of 21,723 arthroplasties, found that the only significant factor for fracture in primary TKA was patient's age.…”

“…The status of the implant fixation should be established; in case of loosening (Rorabeck type III ), TKA revision must be performed 3 . For type I and II fractures, there are two fixation options: retrograde intramedullary nail and locking plates.…”

“…With the growth in the number of total knee arthroplasties (TKA) each year, the frequency of this complication is increasing 3 . The incidence ranges in the literature from 0.3% to 4.2% for primary TKA1, 4 and from 1.6% to 38% for revisions 2, 4.…”

“…The most common mechanism of injury is low-energy trauma. However, elderly patients have little hemodynamic reserve, which increases morbidity and mortality 2, 3. High-energy traumas can occur in 10% of cases 5 …”