Kniegelenksnahe Frakturen bei Knie-TEP

Zusammenfassung

Durch die zunehmende Endoprothetisierung der Bevölkerung nimmt auch die Anzahl an periprothetischen Frakturen insbesondere des Kniegelenks zu. Ca. 95 % aller periprothetischen Frakturen betreffen das distale Femur, etwa 4 % die proximale Tibia. Hauptrisikofaktoren, eine periprothetische Fraktur nach Knieendoprothese zu erleiden, sind aktive Patienten unter 60 Jahren, stattgehabter Endoprothesenwechsel, Osteoporose und, sofern es die periprothetischen Frakturen der Patella betrifft, ein femorales Overstuffing, ein verkürztes Lig. patellae und die Durchführung eines Lateral Releases. Am Femur haben sich als Osteosyntheseverfahren die winkelstabile Plattenosteosynthese oder auch der retrograde Marknagel, welcher biomechanische Vorteile besitzt, durchgesetzt. Drahtcerclagen können die mechanische Stabilität der Osteosynthese erhöhen. Bei gelockerten Implantaten ist i. d. R. der Wechsel auf ein Revisionsimplantat notwendig. Zu beachten ist, dass nach aktueller Studienlage die meisten periprothetischen Frakturen der Tibia mit einem gelockerten Implantat einhergehen, femoral sind die Komponenten meist fest integriert. Periprothetische Frakturen der Patella können zu erheblichen Problemen mit verzögerter Heilung aufgrund der meist problematischen Blutversorgung führen, was bereits bei der Primärimplantation zu berücksichtigen ist. Aufgrund hoher Komplikationsraten von periprothetischen Frakturen am Kniegelenk, die zwischen 12 und 41 % angegeben werden, ist eine optimale Versorgung essenziell.

Abstract

With the increasing number of arthroplasties being performed, an elevated incidence of periprosthetic fractures around the knee can be observed. About 95 % of the fractures are located at the distal femur, 4 % are found at the tibia and 1 % at the patella. The main risk factors to suffer from a periprosthetic fracture around the knee are high activity levels combined with an age lower than 60 years, revisionarthroplasty, long stems and osteoporosis. Femoral overstuffing, patella baja and lateral release are risk factors for patella fractures. At the femoral location, angle stable plates or a retrograde nail are the prefered implants. Cerclage wires enhance the biomechanical stability. Loose implants result in the necessity to perform a revision arthroplasty. According to the current literature, most periprosthetic fractures at the tibial side are accompanied with a loose implant, at the femoral side the implants are stably integrated in most cases. Periprosthetic patella fractures often have healing problems due to an impaired blood supply after an anteromedial arthrotomy. In general there is a high complication rate of 12 to 41 % in the treatment of periprosthetic fractures around the knee. This should be considered for the primary knee arthroplasty as well as in the treatment of the periprosthetic fractures.

• Literatur

• 1 Aaron RK, Scott R. Supracondylar fracture of the femur after total knee arthroplasty. Clin Orthop Relat Res 1987; 219: 136-139
• 2 Adigweme OO, Sassoon AA, Langford J et al. Periprosthetic patellar fractures. J Knee Surg 2013; 26: 313-317
• 3 Aldrian S, Schuster R, Haas N et al. Fixation of supracondylar femoral fractures following total knee arthroplasty: is there any difference comparing angular stable plate fixation versus rigid interlocking nail fixation?. Arch Orthop Trauma Surg 2013; 133: 921-927
• 4 Bae DK, Song SJ, Yoon KH et al. Periprosthetic supracondylar femoral fractures above total knee arthroplasty: comparison of the locking and non-locking plating methods. Knee Surg Sports Traumatol Arthrosc 2014; 22: 2690-2697
• 5 Beals RK, Tower SS. Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res 1996; 327: 238-246
• 6 Berger RA, Meneghini RM, Jacobs JJ et al. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg Am 2005; 87: 999-1006
• 7 Brooks P. Extensor mechanism ruptures. Orthopedics 2009; 32
• 8 Buttaro MA, Farfalli G, Paredes Nunez M et al. Locking compression plate fixation of Vancouver type B1 periprosthetic femoral fractures. J Bone Joint Surg Am 2007; 89: 1964-1969
• 9 Chen F, Mont MA, Bachner RS. Management of ipsilateral supracondylar femur fractures following total knee arthroplasty. J Arthroplasty 1994; 9: 521-526
• 10 Chen SH, Chiang MC, Hung CH et al. Finite element comparison of retrograde intramedullary nailing and locking plate fixation with/without an intramedullary allograft for distal femur fracture following total knee arthroplasty. Knee 2014; 21: 224-231
• 11 Culp RW, Schmidt RG, Hanks G et al. Supracondylar fracture of the femur following prosthetic knee arthroplasty. Clin Orthop Relat Res 1987; 222: 212-222
• 12 Ebraheim NA, Sochacki KR, Liu X et al. Locking plate fixation of periprosthetic femur fractures with and without cerclage wires. Orthop Surg 2013; 5: 183-187
• 13 Ehlinger M, Adam P, Abane L et al. Treatment of periprosthetic femoral fractures of the knee. Knee Surg Sports Traumatol Arthrosc 2011; 19: 1473-1478
• 14 Felix NA, Stuart MJ, Hanssen AD. Periprosthetic fractures of the tibia associated with total knee arthroplasty. Clin Orthop Relat Res 1997; 345: 113-124
• 15 Fulkerson E, Tejwani N, Stuchin S et al. Management of periprosthetic femur fractures with a first generation locking plate. Injury 2007; 38: 965-972
• 16 Gondalia V, Choi DH, Lee SC et al. Periprosthetic supracondylar femoral fractures following total knee arthroplasty: clinical comparison and related complications of the femur plate system and retrograde-inserted supracondylar nail. J Orthop Traumatol 2014; 15: 201-207
• 17 Gujarathi N, Putti AB, Abboud RJ et al. Risk of periprosthetic fracture after anterior femoral notching. Acta Orthop 2009; 80: 553-556
• 18 Ha CW, Shon OJ, Lim SW et al. Minimally invasive plate osteosynthesis for periprosthetic distal femoral fractures after total knee arthroplasty. Knee Surg Relat Res 2014; 26: 27-32
• 19 Hanssen AD, Stuart MJ. Treatment of periprosthetic tibial fractures. Clin Orthop Relat Res 2000; 380: 91-98
• 20 Harlow ML, Hofmann AA. Periprosthetic fractures. In: Scott WN, ed. The Knee. St. Louis, MO: Mosby-Year Book; 1994: 1405-1417
• 21 Herrera DA, Kregor PJ, Cole PA et al. Treatment of acute distal femur fractures above a totalknee arthroplasty – systematic review of 415 cases (1981–2006). Acta Orthop 2008; 79: 22-27
• 22 Keating EM, Haas G, Meding JB. Patella fracture after post total knee replacements. Clin Orthop Relat Res 2003; 416: 93-97
• 23 Kiluçoğlu OI, Akgül T, Sağlam Y et al. Comparison of locked plating and intramedullary nailing for periprosthetic supracondylar femur fractures after knee arthroplasty. Acta Orthop Belg 2013; 79: 417-421
• 24 Kim KI, Egol KA, Hozack WJ et al. Periprosthetic fractures after total knee arthroplasties. Clin Orthop Relat Res 2006; 446: 167-175
• 25 Lachiewicz PF. Periprosthetic fracture between a constrained total knee arthroplasty and a long-stem total hip arthroplasty: treatment with a novel device. J Arthroplasty 2007; 22: 449-452
• 26 Lee SS, Lim SJ, Moon YW et al. Outcomes of long retrograde intramedullary nailing for periprosthetic supracondylar femoral fractures following total knee arthroplasty. Arch Orthop Trauma Surg 2014; 134: 47-52
• 27 Meding JB, Fish MD, Berend ME et al. Predicting patellar failure after total knee arthroplasty. Clin Orthop Relat Res 2008; 466: 2769-2774
• 28 Meneghini RM, Keyes BJ, Reddy KK et al. Modern retrograde intramedullary nails versus periarticular locked plates for supracondylar femur fractures after total knee arthroplasty. J Arthroplasty 2014; 29: 1478-1481
• 29 Ortiguera CJ, Berry DJ. Patella fracture after total knee aerthroplasty. J Bone Joint Surg Am 2002; 84: 532-540
• 30 Pekmezci M, McDonald E, Buckley J et al. Retrograde intramedullary nails with distal screws locked to the nail have higher fatigue strength than locking plates in the treatment of supracondylar femoral fractures: a cadaver-based laboratory investigation. Bone Joint J 2014; 96-B: 114-121
• 31 Reuben JD, McDonald CL, Woodard PL et al. Effect of patella thickness on patella strain following total knee arthro- plasty. J Arthroplasty 1991; 6: 251-258
• 32 Ritter MA, Thong AE, Keating EM et al. The effect of femoral notching during total knee arthroplasty on the prevalence of postoperative femoral fractures and on clinical outcome. J Bone Joint Surg Am 2005; 87: 2411-2414
• 33 Rorabeck CH, Taylor JW. Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin N Am 1999; 30: 209-214
• 34 Ruchholtz S, Tomás J, Gebhard F et al. Periprosthetic fractures around the knee – the best way of treatment. Eur Orthop Traumatol 2013; 4: 93-102
• 35 Rupprecht M, Schlickewei C, Fensky F et al. [Periprosthetic and interimplant femoral fractures: Biomechanical analysis.]. Unfallchirurg 2014; Jun 5 [Epub ahead of print]
• 36 Schüttrumpf JP, Behzadi C, Balcarek P et al. Radiologically hyperdense zones of the patella seem to be partial osteonecroses subsequent to fracture treatment. J Knee Surg 2013; 26: 319-326
• 37 Scuderi G, Scharf SG, Maltzer LP et al. The relationship of lateral releases to patella viability in total knee arthroplasty. J Arthroplasty 1987; 2: 209-214
• 38 Seeger JB, Jaeger S, Röhner E et al. Treatment of periprosthetic tibial plateau fractures in unicompartmental knee arthroplasty: plates versus cannulated screws. Arch Orthop Trauma Surg 2013; 133: 253-257
• 39 Seo JG, Moon YW, Park SH et al. A case-control study of spontaneous patellar fractures following primary total knee replacement. J Bone Joint Surg Br 2012; 94: 908-913
• 40 Singh JA, Jensen M, Lewallen D. Predictors of periprosthetic fracture after total knee replacement. An analysis of 21, 723 cases. Acta Orthopaedica 2013; 84: 170-177
• 41 Sun ZH, Liu YJ, Li H. Femoral Stress and Strain Changes post-Hip, -Knee and -Ipsilateral Hip/Knee Arthroplasties: a Finite Element Analysis. Orthop Surg 2014; 6: 137-144
• 42 Thelen S, Schneppendahl J, Jopen E et al. Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury 2012; 43: 1290-1295
• 43 Vallier HA, Immler W. Comparison of the 95-degree angled blade plate and the locking condylar plate for the treatment of distal femoral fractures. J Orthop Trauma 2012; 26: 327-332
• 44 Wick M, Muller EJ, Muhr G. Supracondylar femoral fractures in knee endoprostheses: stabilizing with retrograde interlocking nail. Unfallchirurg 2001; 104: 410-413
• 45 Xue H, Tu Y, Cai M et al. Locking compression plate and cerclage bond for type B1 periprosthetic femoral fractures. J Arthroplasty 2011; 26: 467-471
• 46 Zalzal P, Backstein D, Gross AE et al. Notching of the anterior femoral cortex during total knee arthroplasty characteristics that increase local stresses. J Arthroplasty 2006; 21: 737-743