Periprosthetic Fracture in Unicompartmental Knee Arthroplasty

  • Anthony J. Boniello
  • Craig J. Della Valle
  • P. Maxwell Courtney


Although rare, periprosthetic fractures following unicompartmental knee arthroplasty (UKA) present a treatment dilemma for the orthopedic surgeon. These fractures are most commonly seen of the medial tibial plateau with femoral fractures occurring much less frequently. Patient-related factors such as disorders, which lead to poor bone quality, may predispose to this complication, while stress risers such as those created by the pinholes used to affix the tibial cutting guide, the vertical tibial cut itself, and tibial component sizing and positioning have been proposed as possible mechanisms. Assessing component stability is the key to management of these injuries. Well-fixed components associated with nondisplaced fractures may be managed nonoperatively with a period of protected weight bearing and/or bracing. Displaced fractures with a stable component should be treated with open reduction and internal fixation using a buttress plate for fixation. If the component is loose, revision to a total knee arthroplasty is required and can be technically challenging.


Unicompartmental knee arthroplasty Periprosthetic fracture Complications Surgical management Conversion to total knee arthroplasty 


  1. 1.
    Kumar A, Chambers I, Wong P. Periprosthetic fracture of the proximal tibia after lateral Unicompartmental knee arthroplasty. J Arthroplast. 2008;23(4):615–8.CrossRefGoogle Scholar
  2. 2.
    Kim KT, Lee S, Cho KH, Kim KS. Fracture of the medial femoral condyle after Unicompartmental knee arthroplasty. J Arthroplast [Internet]. 2009;24(7):1143.e21–4.
  3. 3.
    Rudol G, Jackson MP, James SE. Medial Tibial plateau fracture complicating Unicompartmental knee arthroplasty. J Arthroplast. 2007;22(1):148–50.CrossRefGoogle Scholar
  4. 4.
    Sloper PJH, Hing CB, Donell ST, Glasgow MMS. Intra-operative tibial plateau fracture during unicompartmental knee replacement: a case report. Knee. 2003;10(2003):367–9.CrossRefGoogle Scholar
  5. 5.
    ten Brinke B, de Haan LJ, Koenraadt KLM, van Geenen RCI. Medial femoral condyle fracture as an intraoperative complication of Oxford unicompartmental knee replacement. Knee Surg Sport Traumatol Arthrosc. 2016;24(10):3191–3.CrossRefGoogle Scholar
  6. 6.
    Akan B, Yildirim T, Karaguven D. Medial femoral condyle fracture after cementless unicompartmental knee replacement: a rare complication. Knee [Internet]. 2013;20(4):295–7. Available from:
  7. 7.
    Hung Y-W, Fan JC-H, Kwok CK-B, Wong EL-F. Delayed tibial-platform periprosthetic stress fracture after unicompartmental knee arthroplasty: uncommon and devastating complication. J Orthop Trauma Rehabil [Internet]. 2018;25:29–33. Available from: Scholar
  8. 8.
    Brumby SA, Carrington R, Bs MB, Orth F, Zayontz S, Orth F, et al. Case report Tibial plateau stress fracture a complication of Unicompartmental knee arthroplasty using 4 guide pinholes. J Arthroplast. 2003;18(6):809–12.CrossRefGoogle Scholar
  9. 9.
    Van Loon P, De Munnynck B, Bellemans J. Periprosthetic fracture of the tibial plateau after unicompartmental knee arthroplasty. Acta Orthop Belg. 2006;72(3):369–74.PubMedGoogle Scholar
  10. 10.
    Woo YL, Chin PL, Lo NN, Chia S-L, Tay DKJ, Yeo SJ. Management of periprosthetic fracture in unicompartmental knee arthroplasty patients: a case series. Proc Singapore Healthc [Internet]. 2013;22(4):267–72. Available from: Scholar
  11. 11.
    Pandit H, Murray DW, Dodd C a F, Deo S, Waite J, Goodfellow J, et al. Medial tibial plateau fracture and the Oxford unicompartmental knee. Orthopedics [Internet]. 2007;30(5 Suppl):28–31. Available from: Scholar
  12. 12.
    Ji JH, Park SE, Song IS, Kang H, Ha JY, Jeong JJ. Complications of medial unicompartmental knee arthroplasty. Clin Orthop Surg. 2014;6(4):365–72.CrossRefGoogle Scholar
  13. 13.
    Morris MJ, Molli RG, Berend KR, Lombardi AV. Mortality and perioperative complications after unicompartmental knee arthroplasty. Knee [Internet]. 2013;20(3):218–20. Available from:
  14. 14.
    Kim KT, Lee S, Il LJ, Kim JW. Analysis and treatment of complications after Unicompartmental knee arthroplasty. Knee Surg Relat Res [Internet]. 2016;28(1):46–54. Available from: doi=
  15. 15.
    Bolognesi MP, Greiner MA, Attarian DE, Watters TS, Wellman SS, Curtis LH, et al. Unicompartmental knee arthroplasty and total knee arthroplasty among Medicare beneficiaries, 2000 to 2009. J Bone Joint Surg Am. 2013;95(22):e174.CrossRefGoogle Scholar
  16. 16.
    Dyrhovden GS, Lygre SHL, Badawy M, Gøthesen Ø, Furnes O. Have the causes of revision for Total and Unicompartmental knee arthroplasties changed during the past two decades? Clin Orthop Relat Res. 2017;475(7):1874–86.CrossRefGoogle Scholar
  17. 17.
    Haddad FS, Masri BA, Garbuz DS, Duncan CP. The prevention of periprosthetic fractures in total hip and knee arthroplasty. Orthop Clin North Am [Internet]. 1999 Apr. [cited 2018 Jul 29];30(2):191–207. Available from:
  18. 18.
    Badawy M, Espehaug B, Indrekvam K, Havelin LI, Furnes O. Higher revision risk for unicompartmental knee arthroplasty in low-volume hospitals. Acta Orthop. 2014;85(4):342–7.CrossRefGoogle Scholar
  19. 19.
    Fiocchi A, Condello V, Madonna V, Bonomo M, Zorzi C. Medial vs lateral unicompartmental knee arthrroplasty: clinical results. Acta Biomed [Internet]. 2017 Jun 7 [cited 2018 Jul 29];88(2–S):38–44. Available from:
  20. 20.
    Clarius M, Haas D, Aldinger PR, Jaeger S, Jakubowitz E, Seeger JB. Periprosthetic tibial fractures in unicompartmental knee arthroplasty as a function of extended sagittal saw cuts: an experimental study. Knee [Internet]. 2010;17(1):57–60. Available from:
  21. 21.
    Seeger JB, Jaeger S, Röhner E, Dierkes H, Wassilew G, Clarius M. Treatment of periprosthetic tibial plateau fractures in unicompartmental knee arthroplasty: plates versus cannulated screws. Arch Orthop Trauma Surg. 2013;133(2):253–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Anthony J. Boniello
    • 1
  • Craig J. Della Valle
    • 2
  • P. Maxwell Courtney
    • 3
  1. 1.Drexel University College of Medicine, Department of OrthopaedicsPhiladelphiaUSA
  2. 2.Adult Reconstruction Division, Department of Orthopaedic Surgery, Rush University Medical CenterChicagoUSA
  3. 3.Rothman Orthopaedic Institute, Thomas Jefferson University HospitalPhiladelphiaUSA

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