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Treatment of periprosthetic tibial plateau fractures in unicompartmental knee arthroplasty: plates versus cannulated screws

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Periprosthetic tibial plateau fractures (TPF) are rare but represent a serious complication in unicompartmental knee arthroplasty. The most common treatment for these fractures is osteosynthesis with cannulated screws or plates. The aim of this study was to evaluate two different treatment options for periprosthetic fractures. The hypothesis was that angle-stable plates show significantly higher fracture loads than fixation with cannulated screws.

Materials and methods

Twelve matched, paired fresh-frozen tibiae with periprosthetic TPF were used for this study. In Group A, osteosyntheses with cannulated screws were performed, whereas in Group B plates fixated the periprosthetic fracture. DEXA bone density measurement and standard X-rays (AP and lateral) were performed before loading the tibiae under standardised conditions with a maximum load of up to 10.0 kN. After the specimens had been loaded, fracture patterns and fracture loads were analysed and correlated with BMD, BMI, bodyweight (BW), age and size of the tibial implant.

Results

In the plate group all tibiae fracture occured with a median load of F max = 2.64 (0.45–5.68) kN, whereas in the group with cannulated screws fractures occurred at a mean load of F max = 1.50 (0.27–3.51) kN. The difference was statistically significant at p < 0.05.

Discussion

Angle-stable plates showed significantly higher fracture loads than fixation with cannulated screws. Cannulated screws show a reduced stability of the tibial plateau. Therefore in periprosthetic TPF, osteosyntheses with angle-stable plates should be recommended instead of cannulated screws.

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Conflict of interest

The study was partially supported by Biomet, and the authors of the study disclose the following financial relationships to the company: Dr Clarius serves as a paid consultant for Aesculap and Biomet and has received research or institutional support from Biomet. However, neither Aesculap nor Biomet exerted any influence on the study methods, results, or interpretation of the data. The study was supported by a research grant from the University of Heidelberg.

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Authors and Affiliations

  1. Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstraße 33, 35392, Giessen, Germany

    Joern Bengt Seeger

  2. Department of Orthopaedics, Traumatology and Paraplegiology, Laboratory of Biomechanics and Implant Research, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany

    Joern Bengt Seeger, S. Jaeger & M. Clarius

  3. Department of Traumatology and Orthopaedics, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    E. Röhner & G. Wassilew

  4. OCM, Orthopädische Chirurgie München, Steinerstrasse 6, 81369, Munich, Germany

    H. Dierkes

  5. Department of Orthopaedic and Trauma Surgery, Vulpius Klinik GmbH, Vulpiusstraße 29, 74906, Bad Rappenau, Germany

    M. Clarius

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  1. Joern Bengt Seeger
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  2. S. Jaeger
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  3. E. Röhner
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  4. H. Dierkes
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  5. G. Wassilew
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  6. M. Clarius
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Correspondence to Joern Bengt Seeger.

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Seeger, J.B., Jaeger, S., Röhner, E. et al. Treatment of periprosthetic tibial plateau fractures in unicompartmental knee arthroplasty: plates versus cannulated screws. Arch Orthop Trauma Surg 133, 253–257 (2013). https://doi.org/10.1007/s00402-012-1649-6

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  • DOI: https://doi.org/10.1007/s00402-012-1649-6

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