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A cautionary case: osteoporotic femur fracture after robotic-assisted total knee arthroplasty

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Abstract

Osteoporosis is a disease of low bone mass which leads to an increased risk of fracture. The prevalence of osteoporosis is greatest amongst postmenopausal women who also form a large portion of patients with osteoarthritis presenting for total knee arthroplasty. We present a case of a 77-year-old female with knee osteoarthritis and osteoporosis on denosumab who underwent robotic-assisted total knee arthroplasty. Postoperatively, she suffered an atraumatic midshaft femur fracture at the pin site associated with the use of intraoperative robotic technology. This is a unique complication related to the use of robotics which requires additional skeletal fixation versus standard arthroplasty surgical technique. We recommend caution and further study regarding the use of robotics in total knee arthroplasty in the setting of osteoporosis and denosumab use.

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References

  1. Black DM, Rosen CJ (2016) Postmenopausal osteoporosis. N Engl J Med 374:2096–2097

    Article  Google Scholar 

  2. Bernatz JT, Brooks AE, Squire MW, Illgen RI 2nd, Binkley NC, Anderson PA (2019) Osteoporosis is common and undertreated prior to total joint arthroplasty. J Arthroplast 34:1347–1353

    Article  Google Scholar 

  3. Bautista M, Manrique J, Hozack WJ (2019) Robotics in total knee arthroplasty. J Knee Surg 32:600–606

    Article  Google Scholar 

  4. Khlopas A, Sodhi N, Sultan AA, Chughtai M, Molloy RM, Mont MA (2018) Robotic arm-assisted total knee arthroplasty. J Arthroplast 33:2002–2006

    Article  Google Scholar 

  5. Bonutti P, Dethmers D, Stiehl JB (2008) Case report : femoral shaft fracture resulting from femoral tracker placement in navigated TKA. Clin Orthop Relat Res 466:1499–1502

    Article  Google Scholar 

  6. Lonner JH, Fillingham YA (2018) Pros and Cons: A balanced view of robotics in knee arthroplasty. J Arthroplast 33:2007–2013. https://doi.org/10.1016/j.arth.2018.03.056

    Article  Google Scholar 

  7. Wysocki RW, Sheinkop MB, Virkus WW, Della Valle CJ (2008) Femoral fracture through a previous pin site after computer-assisted total knee arthroplasty. J Arthroplast 23:462–465

    Article  Google Scholar 

  8. Brown MJ, Matthews JR, Bayers-Thering MT, Phillips MJ, Krackow KA (2017) Low incidence of postoperative complications with navigated total knee arthroplasty. J Arthroplast 32:2120–2126. https://doi.org/10.1016/j.arth.2017.01.045

    Article  Google Scholar 

  9. Hoke D, Jafari SM, Orozco F, Ong A (2011) Tibial shaft stress fractures resulting from placement of navigation tracker pins. J Arthroplast 26:504.e5–504.e8

    Article  Google Scholar 

  10. Beldame J, Boisrenoult P, Beaufils P (2010) Pin track induced fractures around computer-assisted TKA. Orthop Traumatol Surg Res 96:249–255

    Article  CAS  Google Scholar 

  11. Jung H-J, Jung Y-B, Song K-S, Park S-J, Lee J-S (2007) Fractures associated with computer-navigated total knee arthroplasty. A report of two cases. J Bone Joint Surg Am 89:2280–2284

    Article  Google Scholar 

  12. Jung KA, Lee SC, Ahn NK, Song MB, Nam CH, Shon OJ (2011) Delayed femoral fracture through a tracker pin site after navigated total knee arthroplasty. J Arthroplast 26:505.e9–505.e11

    Article  Google Scholar 

  13. Li C-H, Chen T-H, Su Y-P, Shao P-C, Lee K-S, Chen W-M (2008) Periprosthetic femoral supracondylar fracture after total knee arthroplasty with navigation system. J Arthroplast 23:304–307

    Article  Google Scholar 

  14. Ossendorf C, Fuchs B, Koch P (2006) Femoral stress fracture after computer navigated total knee arthroplasty. Knee 13:397–399

    Article  Google Scholar 

  15. Panasiuk M, Bończak O (2009) Fatigue fracture of the femur after navigated total knee replacement. Ortop Traumatol Rehabil 11:72–77

    PubMed  Google Scholar 

  16. Brooks DB, Burstein AH, Frankel VH (1970) The biomechanics of torsional fractures. J Bone Joint Surgery 52:507–514. https://doi.org/10.2106/00004623-197052030-00008

    Article  CAS  Google Scholar 

  17. Parvizi J, Jain N, Schmidt AH (2008) Periprosthetic knee fractures. J Orthop Trauma 22:663–671

    Article  Google Scholar 

  18. Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR et al (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361:756–765

    Article  CAS  Google Scholar 

  19. Bone HG, Wagman RB, Brandi ML, Brown JP, Chapurlat R, Cummings SR, Czerwiński E, Fahrleitner-Pammer A, Kendler DL, Lippuner K, Reginster JY, Roux C, Malouf J, Bradley MN, Daizadeh NS, Wang A, Dakin P, Pannacciulli N, Dempster DW, Papapoulos S (2017) 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol 5:513–523

    Article  CAS  Google Scholar 

  20. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CYC (2005) Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 90:1294–1301

    Article  CAS  Google Scholar 

  21. Schilcher J, Aspenberg P (2014) Atypical fracture of the femur in a patient using denosumab – a case report. Acta Orthop 85:6–7. https://doi.org/10.3109/17453674.2014.885355

    Article  PubMed  PubMed Central  Google Scholar 

  22. Drampalos E, Skarpas G, Barbounakis N, Michos I (2014) Atypical femoral fractures bilaterally in a patient receiving denosumab. Acta Orthop 85:3–5

    Article  Google Scholar 

  23. Paparodis R, Buehring B, Pelley E, Binkley N (2013) A case of an unusual subtrochanteric fracture in a patient receiving denosumab. Endocr Pract 19:e64–e68. https://doi.org/10.4158/ep12367.cr

    Article  PubMed  Google Scholar 

  24. Thompson RN, Armstrong CL, Heyburn G (2014) Bilateral atypical femoral fractures in a patient prescribed denosumab - a case report. Bone 61:44–47

    Article  Google Scholar 

  25. Boivin GY, Chavassieux PM, Santora AC, Yates J, Meunier PJ (2000) Alendronate increases bone strength by increasing the mean degree of mineralization of bone tissue in osteoporotic women. Bone 27:687–694. https://doi.org/10.1016/s8756-3282(00)00376-8

    Article  CAS  PubMed  Google Scholar 

  26. Turner CH (2002) Biomechanics of bone: determinants of skeletal fragility and bone quality. Osteoporos Int 13:97–104

    Article  CAS  Google Scholar 

  27. Lloyd AA, Gludovatz B, Riedel C, Luengo EA, Saiyed R, Marty E, Lorich DG, Lane JM, Ritchie RO, Busse B, Donnelly E (2017) Atypical fracture with long-term bisphosphonate therapy is associated with altered cortical composition and reduced fracture resistance. Proc Natl Acad Sci U S A 114:8722–8727

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Rowan University School of Osteopathic Medicine, Stratford, NJ, USA

    H. E. Skibicki

  2. Rothman Orthopaedic Institute, Egg Harbor Township, NJ, USA

    D. Y. Ponzio, J. A. Brustein, Z. D. Post & A. C. Ong

  3. Orozco Orthopaedics, Linwood, NJ, USA

    F. R. Orozco

Authors
  1. H. E. Skibicki
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  2. D. Y. Ponzio
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  3. J. A. Brustein
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  4. Z. D. Post
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  5. A. C. Ong
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  6. F. R. Orozco
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Corresponding author

Correspondence to F. R. Orozco.

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Skibicki, H.E., Ponzio, D.Y., Brustein, J.A. et al. A cautionary case: osteoporotic femur fracture after robotic-assisted total knee arthroplasty. Osteoporos Int 32, 2125–2129 (2021). https://doi.org/10.1007/s00198-021-05977-5

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  • DOI: https://doi.org/10.1007/s00198-021-05977-5

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