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DOI: 10.1055/a-1542-9192
Intraoperative Fractures of the Tibia and Femur in Knee Revision Surgery
Article in several languages: English | deutschAbstract
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 jointPublication History
Article published online:
08 September 2021
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References/Literatur
- 1 Purudappa PP, Ramanan SP, Tripathy SK. et al. Intra-operative fractures in primary total knee arthroplasty – a systematic review. Knee Surg Relat Res 2020; 32: 40 DOI: 10.1186/s43019-020-00054-3.
- 2 Berry DJ. Epidemiology: hip and knee. Orthop Clin North Am 1999; 30: 183-190 DOI: 10.1016/s0030-5898(05)70073-0.
- 3 Hernigou P, Mathieu G, Filippini P. et al. [Intra- and postoperative fractures of the femur in total knee arthroplasty: risk factors in 32 cases]. Rev Chir Orthop Reparatrice Appar Mot 2006; 92: 140-147 DOI: 10.1016/s0035-1040(06)75699-9.
- 4 Alden KJ, Duncan WH, Trousdale RT. et al. Intraoperative fracture during primary total knee arthroplasty. Clin Orthop Relat Res 2010; 468: 90-95 DOI: 10.1007/s11999-009-0876-9.
- 5 Delasotta LA, Orozco F, Miller AG. et al. Distal femoral fracture during primary total knee arthroplasty. J Orthop Surg (Hong Kong) 2015; 23: 202-204 DOI: 10.1177/230949901502300218.
- 6 Pinaroli A, Piedade SR, Servien E. et al. Intraoperative fractures and ligament tears during total knee arthroplasty. A 1795 posterostabilized TKA continuous series. Orthop Traumatol Surg Res 2009; 95: 183-189 DOI: 10.1016/j.otsr.2008.04.002.
- 7 Lombardi jr. AV, Mallory TH, Waterman RA. et al. Intercondylar distal femoral fracture. An unreported complication of posterior-stabilized total knee arthroplasty. J Arthroplasty 1995; 10: 643-650 DOI: 10.1016/s0883-5403(05)80209-8.
- 8 Duncan CP, Haddad FS. The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J 2014; 96-B: 713-716 DOI: 10.1302/0301-620X.96B6.34040.
- 9 Lewis P, Rorabeck C. Revision total Knee Arthroplasty. Baltimore: Williams & Wilkins; 1997
- 10 Felix NA, Stuart MJ, Hanssen AD. Periprosthetic fractures of the tibia associated with total knee arthroplasty. Clin Orthop Relat Res 1997; (345) 113-124
- 11 Cipriano CA, Brown NM, Della Valle CJ. et al. Intra-operative periprosthetic fractures associated with press fit stems in revision total knee arthroplasty: incidence, management, and outcomes. J Arthroplasty 2013; 28: 1310-1313 DOI: 10.1016/j.arth.2012.10.003.
- 12 Chalmers BP, Desy NM, Pagnano MW. et al. Survivorship of Metaphyseal Sleeves in Revision Total Knee Arthroplasty. J Arthroplasty 2017; 32: 1565-1570 DOI: 10.1016/j.arth.2016.12.004.
- 13 Gill UN, Ahmed N, Noor SS. et al. Management of the bone loss by metaphyseal sleeves in primary and revision knee arthroplasty: clinical experience and outcome after forty three cases. Int Orthop 2020; 44: 2315-2320 DOI: 10.1007/s00264-020-04663-1.
- 14 Haddad FS, Masri BA, Garbuz DS. et al. The prevention of periprosthetic fractures in total hip and knee arthroplasty. Orthop Clin North Am 1999; 30: 191-207 DOI: 10.1016/s0030-5898(05)70074-2.
- 15 Schreiner AJ, Schmidutz F, Ateschrang A. et al. Periprosthetic tibial fractures in total knee arthroplasty – an outcome analysis of a challenging and underreported surgical issue. BMC Musculoskelet Disord 2018; 19: 323 DOI: 10.1186/s12891-018-2250-0.
- 16 Gelinas JJ, Ries MD. Treatment of an intraoperative patellar fracture during revision total knee arthroplasty. J Arthroplasty 2002; 17: 1066-1069 DOI: 10.1054/arth.2002.34813.
- 17 Hawellek T, Lehmann W, von Lewinski G. [Periprosthetic fractures around the knee]. Chirurg 2020; 91: 833-840 DOI: 10.1007/s00104-020-01212-9.
- 18 Sarmah SS, Patel S, Reading G. et al. Periprosthetic fractures around total knee arthroplasty. Ann R Coll Surg Engl 2012; 94: 302-307 DOI: 10.1308/003588412X13171221592537.
- 19 Zainul-Abidin S, Lim B, Bin-Abd-Razak HR. et al. Periprosthetic Fractures after Total Knee Arthroplasty: the Influence of Pre-Operative Mechanical Factors versus Intraoperative Factors. Malays Orthop J 2019; 13: 28-34 DOI: 10.5704/MOJ.1907.005.
- 20 Sassoon AA, Nelms NJ, Trousdale RT. Intraoperative fracture during staged total knee reimplantation in the treatment of periprosthetic infection. J Arthroplasty 2014; 29: 1435-1438 DOI: 10.1016/j.arth.2014.01.021.
- 21 Sassoon AA, Wyles CC, Norambuena Morales GA. et al. Intraoperative fracture during aseptic revision total knee arthroplasty. J Arthroplasty 2014; 29: 2187-2191 DOI: 10.1016/j.arth.2014.05.009.
- 22 Ruchholtz S, Tomas J, Gebhard F. et al. Periprosthetic fractures around the knee-the best way of treatment. Eur Orthop Traumatol 2013; 4: 93-102 DOI: 10.1007/s12570-012-0130-x.
- 23 Damsgaard CW, Gad BV, Bono OJ. et al. Intraoperative Proximal Tibia Periprosthetic Fractures in Primary Total Knee Arthroplasty. J Knee Surg 2020; DOI: 10.1055/s-0040-1708037.