The challenge of total knee arthroplasty periprosthetic fracture: a comprehensive review

Abstract

Total knee arthroplasty (TKA) is a common procedure in orthopeadic surgery. It has been estimated that the incidence of periprosthetic fractures after TKA ranged between 0.3 to 2.5%, but increases to 38% when considering revision TKA. Patient-related risk factors for TKA periprosthetic fracture (TKAPF) include osteoporosis, age, female gender, revision arthroplasty and osteolysis. The choice of the most appropriate fixation device of TKAPF is a matter of debate, considering that locking plates and retrograde intramedullary are both associated with good outcomes in terms of fracture union and joint function. In case of prosthetic component instability, severe comminution or metaphyseal extension of the fracture that precludes fixation, failure of previous treatments, and severe malalignment of the TKA, revision TKA (RTKA) should be considered. Severe bone loss is another issue of concern, that might be addressed using both megaprosthesis or allograft-prosthesis composite. Considering the variability of the clinical scenario of TKAPF, a comprehensive approach based on both fracture fixation and/or revision arthroplashty is needed.