Abstract
Intra-operative fractures in knee revision surgery are relatively rare and have not
been well studied. They may occur during joint exposition, removal of the prosthesis
or cement, or implantation of trial or original components. The fractures affect both
the metaphyseal area and diaphysis of the tibia and femur. Tibial fractures are slightly
more common than femur fractures. On the femur, the medial condyle is most frequently
affected, followed by the femur diaphysis. The use of non-cemented stems is associated
with a greater risk of intra-operative diaphyseal fractures than that of cemented
stems. Overall, women and patients with an osteopenic bone structure have a higher
risk of fractures. It is common that fractures are diagnosed post-operatively. In
these cases, conservative therapy may be successful, depending on the stability of
the prosthesis and bones. The most common surgical fixation options are cerclages
and screws, followed by stem extensions for bridging the
fracture. Plate fixation or use of strut grafts are also sensible therapy options.
Overall, intraoperative fractures have a high healing potential with stable and good
joint function. The revision rate is still 15%, which is most often caused by peri-prosthetic
infection.
Key words
intra-operative fracture - knee revision - revision arthroplasty - peri-prosthetic
fracture - knee joint
