Intra-operative tibial fracture during computer assisted total knee replacement: a case report

  • A. ManzottiEmail author
  • N. Confalonieri
  • C. Pullen


Recently computer-assisted joint replacement surgery has been introduced to improve implant alignment. To date no intra-operative fractures have been reported related to the insertion of the navigation trackers used in this technique. The authors present the case of a 76-year-old man who sustained an intra-operative tibial fracture at the site of insertion of the navigation tracker during computer assisted total knee replacement.


Knee Computer assisted replacement Complication 


  1. 1.
    Alan RK, Shin MS, Tria AJ Jr (2007) Initial experience with electromagnetic navigation in total knee arthroplasty: a radiographic comparative study. J Knee Surg 20(2):152–157PubMedGoogle Scholar
  2. 2.
    Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J (2004) Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 86:682–687PubMedCrossRefGoogle Scholar
  3. 3.
    Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R et al (2004) Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 428:26–34PubMedCrossRefGoogle Scholar
  4. 4.
    Brooks DB, Burstein AH, Frankel VH (1970) The biomechanics of torsional fractures: the stress concentration effect of a drill hole. J Bone Joint Surg 52-A:507–514Google Scholar
  5. 5.
    Caillouette JT, Anzel SH (1990) Fat embolism syndrome following the intramedullary alignment guide in total knee arthroplasty. Clin Orthop Relat Res 251:198–199PubMedGoogle Scholar
  6. 6.
    Callaghan JJ, Liu SS, Warth LC (2006) Computer-assisted surgery: a wine before its time: in the affirmative. J Arthroplasty 21(4 Suppl 1):27–28PubMedCrossRefGoogle Scholar
  7. 7.
    Chauhan SK, Scott RG, Breidahl W, Beaver RJ (2004) Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br 86:372–377PubMedCrossRefGoogle Scholar
  8. 8.
    Chin PL, Yang KY, Yeo SJ, Lo NN (2005) Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty 20:618–626PubMedCrossRefGoogle Scholar
  9. 9.
    Church JS, Scadden JE, Gupta RR, Cokis C, Williams KA, Janes GC (2007) Embolic phenomena during computer-assisted and conventional total knee replacement. J Bone Joint Surg Br 89(4):481–485PubMedCrossRefGoogle Scholar
  10. 10.
    Clemens U, Miehlke RK (2005) Advanced navigation planning including soft tissue management. Orthopedics 28(10 Suppl):s1259–s1262. (Review)PubMedGoogle Scholar
  11. 11.
    Confalonieri N, Manzotti A, Pullen C, Ragone V (2005) Computer-assisted technique versus intramedullary and extramedullary alignment systems in total knee replacement: a radiological comparison. Acta Orthop Belg 71:703–709PubMedGoogle Scholar
  12. 12.
    Hemigou P, Deschamps G (2004) Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 423:161–165CrossRefGoogle Scholar
  13. 13.
    Hernandez-Vaquero D, Suarez-Vazquez A (2007) Complications of fixed infrared emitters in computer-assisted total knee arthroplasties. BMC Musculoskelet Disord 8:71PubMedCrossRefGoogle Scholar
  14. 14.
    Hozack WJ (2007) Computer-assisted surgery. Orthopedics 30(2):109–110PubMedGoogle Scholar
  15. 15.
    Jamal SA, Bauer DC, Ensured KE, Cauley JA, Hochberg M, Ishani A, Cummings SR (2007) Alendonate treatment in women with normal to severely impaired renal function: an analysis of the fracture intervention trial. J Bone Miner Res 22(4):503–508PubMedCrossRefGoogle Scholar
  16. 16.
    Jamal SA, Hayden JA, Beyene J (2007) Low bone mineral density and fractures in long-term hemodialysis patients: meta analysis. Am J Kidney Dis 49(5):674–681PubMedCrossRefGoogle Scholar
  17. 17.
    Jenny JY,.Boeri C. (2001) Computer-assisted implantation of a total knee arthroplasty: a case-controlled study in comparison with classical instrumentation. Rev Chir Orthop Reparative Appar Mot 87:645–652Google Scholar
  18. 18.
    Kalairajah Y, Cossey AJ, Verrall GM, Ludbrook G, Spriggins AJ (2006) Are systemic emboli reduced in computer-assisted knee surgery?: a prospective, randomised, clinical trial. J Bone Joint Surg Br 88(2):198–202PubMedCrossRefGoogle Scholar
  19. 19.
    Kalairajah Y, Simpson D, Cossey AJ, Verrall GM, Spriggins AJ (2005) Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Joint Surg Br 87:1480–1482PubMedCrossRefGoogle Scholar
  20. 20.
    Kim SJ, MacDonald M, Hernandez J, Wixson RL (2005) Computer assisted navigation in total knee arthroplasty: improved coronal alignment. J Arthroplasty 20:123–131PubMedCrossRefGoogle Scholar
  21. 21.
    Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59:77–79PubMedGoogle Scholar
  22. 22.
    Mihalko WM, Duquin T, Axelrod JR, Bayers-Thering M, Krackow KA (2006) Effect of one- and two-pin reference anchoring systems on marker stability during total knee arthroplasty computer navigation. Comput Aided Surg 11(2):93–98PubMedCrossRefGoogle Scholar
  23. 23.
    Mihalko WM, Duquin T, Axelrod JR, Fisher L (2007) Location and number of cortical fixation points and the effect on reference base stability during computer-navigated total knee arthroplasty. J Arthroplasty 22(4):605–608PubMedCrossRefGoogle Scholar
  24. 24.
    Monto RR, Garcia J, Callaghan JJ (1990) Fatal fat embolism following total condylar knee arthroplasty. J Arthroplasty 5(4):291–299PubMedCrossRefGoogle Scholar
  25. 25.
    Ossendorf C, Fuchs B, Koch P (2006) Femoral stress fracture after computer navigated total knee arthroplasty. Knee 13:397–399PubMedCrossRefGoogle Scholar
  26. 26.
    Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156PubMedGoogle Scholar
  27. 27.
    Sikorski JM, Blythe MC (2005) Learning the vagaries of computer-assisted total knee replacement. J Bone Joint Surg Br 87(7):903–910PubMedCrossRefGoogle Scholar
  28. 28.
    Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br 85:830–835PubMedGoogle Scholar
  29. 29.
    Yau WP, Ng TP, Chiu KY (2001) Unusual complication associated with femoral intramedullary alignment guide in total knee arthroplasty. J Arthroplasty 16(2):247–249PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Ist Orthopedic DepartmentC.T.O. Hospital, Istituti Clinici di PerfezionamentoMilanItaly
  2. 2.Mercy Private HospitalEast MelbourneAustralia
  3. 3.Cambiago, MilanItaly

Personalised recommendations