J Knee Surg 2021; 34(12): 1269-1274
DOI: 10.1055/s-0040-1708037
Original Article

Intraoperative Proximal Tibia Periprosthetic Fractures in Primary Total Knee Arthroplasty

Christopher W. Damsgaard
1   Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
,
Bishoy V. Gad
2   Department of Orthopedic Surgery, Sports and Orthopaedic Specialists, Edina, Minnesota
,
Olivia J. Bono
3   Department of Research, New England Baptist Hospital, Boston, Massachusetts
,
Marie C. Anderson
3   Department of Research, New England Baptist Hospital, Boston, Massachusetts
,
Jonathon M. Brown
4   Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts
,
James V. Bono
4   Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts
,
Carl T. Talmo
4   Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts
› Author Affiliations
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Abstract

Intraoperative fracture of the proximal tibia is a rare complication of total knee arthroplasty (TKA) with few studies available reporting risk factors or prognosis. A review of our prospective joint registry was performed to determine the incidence and associated risk factors of intraoperative tibia fractures during primary TKA; 14,966 TKAs of all manufacturers were performed with 9 intraoperative tibia fractures. All fractures occurred in a single TKA design. There were 8,155 TKAs of this design performed with a fracture incidence of 0.110%. All but one fracture occurred on the medial tibial plateau, and all but one occurred during preparation of the tibia with keel punching. A control group of 75 patients (80 knees) with the same TKA design were randomly selected. Baseplates size 3 or smaller were less likely to experience an intraoperative fracture (odds ratio [OR]: 0.864, 95% confidence interval [CI]: 0.785–0.951), as were knees with a polyethylene insert thickness of 13 mm or larger (OR: 0.882, 95% CI: 0.812–0.957). Fractures were treated with a variety of different methods, but every patient had at least one screw placed and most (67%) had postoperative weight-bearing restrictions. At final follow-up, there were no cases of nonunion, component subsidence, or need for reoperation. Intraoperative tibia fractures are a rare complication of this TKA design at 0.11%. Knees with baseplates of size ≤3 and polyethylene thickness ≥13 mm were less likely to experience intraoperative fracture. These findings may be related to the depth of tibial resection, requiring the use of a thicker polyethylene insert, and a change in the keel width in implants size 4 or larger. No fracture patients required reoperation.



Publication History

Received: 04 August 2019

Accepted: 23 January 2020

Article published online:
27 May 2020

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