Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 10, pp 3272–3279 | Cite as

The incidence of implant fractures after knee arthroplasty

  • Magdalena M. Gilg
  • Christian W. Zeller
  • Lukas Leitner
  • Andreas Leithner
  • Gerold Labek
  • Patrick SadoghiEmail author



This study aimed to evaluate the incidence of “implant” fractures after knee arthroplasty using clinical literature and worldwide arthroplasty registers. The hypothesis was that register datasets report higher rates of these rare complications than clinical studies.


Calculations were based on the pooled incidence of revision operations after fractures of knee arthroplasties, comparing clinical studies published in MEDLINE-listed journals and annual reports from worldwide arthroplasty registers in a structured literature analysis based on a standardized methodology.


Twelve clinical studies and datasets from six worldwide registers were included. Rates of fractures of knee arthroplasties were reported from 0.2 to 2.5 % in clinical studies versus 0.02–0.17 % in worldwide arthroplasty registers.


Fractures of knee arthroplasty systems are rare complications, with clinical studies showing higher incidence rates than worldwide arthroplasty registries. Unicompartmental knee arthroplasty (UKA) implanted before 2000, constrained primary or revision constrained total knee arthroplasties, and patellar replacements showed the highest incidence of implant fracture. The results of this analysis can help clinicians to counsel patients on potential complications following knee arthroplasty.

Level of evidence



Implant Fracture Breakage Knee Arthroplasty TKA TKR Replacement 



Body mass index


Knee arthroplasty


Observed component years


Quality of literature in arthroplasty


Total knee arthroplasty


Unicompartmental knee arthroplasty


Authors’ contribution

MMG contributed to conception and design, acquisition of data, interpretation of data, and drafting of manuscript. CWZ contributed to conception and design, acquisition of data, and revising the manuscript. LL contributed to analysis and interpretation of data and revising the manuscript. AL contributed to interpretation of data and revising the manuscript. GL contributed to conception and design and analysis and interpretation of data. PS contributed to conception and design, interpretation of data, and revising the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Conflict of interests

The authors did not receive financial support for this study, and there are no known conflicts of interest associated with this publication that could have influenced its outcome.


  1. 1.
    Abernethy PJ, Robinson CM, Fowler RM (1996) Fracture of the metal tibial tray after Kinematic total knee replacement. A common cause of early aseptic failure. J Bone Jt Surg Br 78:220–225Google Scholar
  2. 2.
    Ansari S, Newman JH, Ackroyd CE (1997) St. Georg sledge for medial compartment knee replacement. 461 arthroplasties followed for 4 (1–17) years. Acta Orthop Scand 68:430–434CrossRefPubMedGoogle Scholar
  3. 3.
    Ashraf T, Newman JH, Evans RL, Ackroyd CE (2002) Lateral unicompartmental knee replacement survivorship and clinical experience over 21 years. J Bone Jt Surg Br 84:1126–1130CrossRefGoogle Scholar
  4. 4.
    Annual Report 2013, Australian Orthopaedic Association- National Joint Replacement Registry,
  5. 5.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ (2010) The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 468:45–51CrossRefPubMedGoogle Scholar
  6. 6.
    Annual Report (2013) Canadian Joint Replacement Registry.
  7. 7.
    Crowe B, Payne A, Evangelista PJ, Stachel A, Phillips MS, Slover JD, Inneh IA, Iorio R, Bosco JA (2015) Risk factors for infection following total knee arthroplasty: a series of 3836 cases from one institution. J Arthroplasty 30:2275–2278CrossRefPubMedGoogle Scholar
  8. 8.
    Dalury DF, Pomeroy DL, Gorab RS, Adams MJ (2013) Why are total knee arthroplasties being revised? J Arthroplasty 28:120–121CrossRefPubMedGoogle Scholar
  9. 9.
    David HG, Bishay M, James ET (1998) Problems with the Rotaflex: a 10 year review of a rotating hinge prosthesis. J Arthroplasty 13:402–408CrossRefPubMedGoogle Scholar
  10. 10.
    Deehan DJ, Murray JD, Birdsall PD, Pinder IM (2006) Quality of life after knee revision arthroplasty. Acta Orthop 77:761–766CrossRefPubMedGoogle Scholar
  11. 11.
    Doll R, Hill AB (1956) Lung cancer and other causes of death in relation to smoking; a second report on the mortality of British doctors. Br Med J 2:1071–1081CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Finish Arthroplasty Register, Statistical Report 2011.
  13. 13.
    Friesenbichler J, Schwarzkopf R, Sadoghi P, Marwin SE, Glehr M, Maurer-Ertl W, Leithner A (2012) Failure rate of a rotating hinge knee design due to yoke fracture of the hinged tibial insert: a retrospective data analysis and review of the literature. Int Orthop 36:993–998CrossRefPubMedGoogle Scholar
  14. 14.
    Furnes O, Espehaug B, Lie SA, Vollset SE, Engesaeter LB, Havelin LI (2002) Early failures among 7,174 primary total knee replacements: a follow-up study from the Norwegian Arthroplasty Register 1994–2000. Acta Orthop Scand 73:117–129CrossRefPubMedGoogle Scholar
  15. 15.
    Hwang N, Grimer RJ, Carter SR, Tillman RM, Abudu A, Jeys LM (2012) Early results of a non-invasive extendible prosthesis for limb-salvage surgery in children with bone tumours. J Bone Jt Surg Br 94:265–269CrossRefGoogle Scholar
  16. 16.
    Labek G (2011) Quality of publications regarding the outcome of revision rate after arthroplasty. Final Report of the QoLA Project, EAR Publication
  17. 17.
    Lewold S, Robertsson O, Knutson K, Lidgren L (1998) Revision of unicompartmental knee arthroplasty: outcome in 1,135 cases from the Swedish Knee Arthroplasty study. Acta Orthop Scand 69:469–474CrossRefPubMedGoogle Scholar
  18. 18.
    Manzotti A, Chemello C, Pullen C, Cerveri P, Confalonieri N (2013) An uncommon cause of cemented unicompartmental knee arthroplasty failure: fracture of metallic components. Knee Surg Sports Traumatol Arthrosc 21:2518–2522CrossRefPubMedGoogle Scholar
  19. 19.
  20. 20.
    Necas L, Katina S, Uhlarova J, Colton CL (2013) Survival analysis of total hip and knee replacement in Slovakia 2003–2011.
  21. 21.
    Fourteen-year Report, New Zealand Orthopaedic Association: The New Zealand Joint Registry.
  22. 22.
    Panousis K, Murnaghan C, Koettig P, Grigoris P (2004) Fracture of the femoral component of a Brigham unicompartmental knee: a case report. Knee Surg Sports Traumatol Arthrosc 12:307–310CrossRefPubMedGoogle Scholar
  23. 23.
    Robertsson O (2007) Knee arthroplasty registers. J Bone Jt Surg Br 89:1–4CrossRefGoogle Scholar
  24. 24.
    Sadoghi P, Pawelka W, Liebensteiner MC, Williams A, Leithner A, Labek G (2014) The incidence of implant fractures after total hip arthroplasty. Int Orthop 38:39–46CrossRefPubMedGoogle Scholar
  25. 25.
    Sadoghi P, Liebensteiner M, Agreiter M, Leithner A, Bohler N, Labek G (2013) Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers. J Arthroplasty 28:1329–1332CrossRefPubMedGoogle Scholar
  26. 26.
    Schuh R, Neumann D, Rauf R, Hofstaetter J, Boehler N, Labek G (2012) Revision rate of Birmingham Hip Resurfacing arthroplasty: comparison of published literature and arthroplasty register data. Int Orthop 36:1349–1354CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O, Rasmussen S (2015) A randomized, controlled trial of total knee replacement. N Engl J Med 373:1597–1606CrossRefPubMedGoogle Scholar
  28. 28.
    Smith TH, Gad BV, Klika AK, Styron JF, Joyce TA, Barsoum WK (2013) Comparison of mechanical and nonmechanical failure rates associated with rotating hinged total knee arthroplasty in nontumor patients. J Arthroplasty 28(62–7):e1Google Scholar
  29. 29.
    Springer BD, Sim FH, Hanssen AD, Lewallen DG (2004) The modular segmental kinematic rotating hinge for nonneoplastic limb salvage. Clin Orthop Relat Res 421:181–187CrossRefPubMedGoogle Scholar
  30. 30.
    Steele RG, Hutabarat S, Evans RL, Ackroyd CE, Newman JH (2006) Survivorship of the St Georg Sled medial unicompartmental knee replacement beyond ten years. J Bone Jt Surg Br 88:1164–1168CrossRefGoogle Scholar
  31. 31.
    Swamy GN, Quah C, Bagouri E, Badhe NP (2014) Nontraumatic fracture of the femoral condylar prosthesis in a total knee arthroplasty leading to mechanical failure. Case Rep Orthop 2014:896348PubMedPubMedCentralGoogle Scholar
  32. 32.
    Thiele K, Perka C, Matziolis G, Mayr HO, Sostheim M, Hube R (2015) Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery. J Bone Jt Surg Am 97:715–720CrossRefGoogle Scholar
  33. 33.
    Unwin PS, Cobb JP, Walker PS (1993) Distal femoral arthroplasty using custom-made prostheses. The first 218 cases. J Arthroplasty 8:259–268CrossRefPubMedGoogle Scholar
  34. 34.
    Vessely MB, Whaley AL, Harmsen WS, Schleck CD, Berry DJ (2006) The Chitranjan Ranawat Award: long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties. Clin Orthop Relat Res 452:28–34CrossRefPubMedGoogle Scholar
  35. 35.
    Wang H, Lou H, Zhang H, Jiang J, Liu K (2014) Similar survival between uncemented and cemented fixation prostheses in total knee arthroplasty: a meta-analysis and systematic comparative analysis using registers. Knee Surg Sports Traumatol Arthrosc 22:3191–3197CrossRefPubMedGoogle Scholar
  36. 36.
    Whiteside LA, Fosco DR, Brooks JG Jr (1993) Fracture of the femoral component in cementless total knee arthroplasty. Clin Orthop Relat Res 286:71–77PubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Magdalena M. Gilg
    • 1
  • Christian W. Zeller
    • 2
  • Lukas Leitner
    • 1
  • Andreas Leithner
    • 1
  • Gerold Labek
    • 3
  • Patrick Sadoghi
    • 1
    Email author
  1. 1.Department of Orthopedic SurgeryMedical University of GrazGrazAustria
  2. 2.Department of Trauma SurgeryUniversity Hospital RegensburgRegensburgGermany
  3. 3.Department of Orthopedic SurgeryMedical University of InnsbruckInnsbruckAustria

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