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Periprosthetic fractures about total knee arthroplasty

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Abstract

Periprosthetic fracture after total knee arthroplasty presents a difficult complication for many orthopaedic surgeons. These fractures occur most frequently around the distal femur followed by the patella and then tibia. These fractures are frequently complicated by poor bone quality or compromised bone due to the presence of the implants. Surgical treatment is typically necessary and requires varied techniques of open fixation, intramedullary fixation, or revision arthroplasty. Outcomes of these injuries vary widely. This review aims to describe the epidemiology, classification, treatment options and outcomes for periprosthetic fractures following total knee arthroplasty.

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References

  1. Hoffmann MF, Jones CB, Sietsema DL et al (2012) Outcome of periprosthetic distal femoral fractures following knee arthroplasty. Injury 43:1084–1089. https://doi.org/10.1016/j.injury.2012.01.025

    Article  CAS  PubMed  Google Scholar 

  2. Meneghini RM, Keyes BJ, Reddy KK, Maar DC (2014) Modern retrograde intramedullary nails versus periarticular locked plates for supracondylar femur fractures after total knee arthroplasty. J Arthroplasty 29:1478–1481. https://doi.org/10.1016/j.arth.2014.01.025

    Article  PubMed  Google Scholar 

  3. Gavaskar AS, Tummala NC, Subramanian M (2013) The outcome and complications of the locked plating management for the periprosthetic distal femur fractures after a total knee arthroplasty. Clin Orthop Surg 5:124–128. https://doi.org/10.4055/cios.2013.5.2.124

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hou Z, Bowen TR, Irgit K et al (2012) Locked plating of periprosthetic femur fractures above total knee arthroplasty. J Orthop Trauma 26:427–432. https://doi.org/10.1097/BOT.0b013e31822c050b

    Article  PubMed  Google Scholar 

  5. Horneff JG, Scolaro JA, Jafari SM et al (2013) Intramedullary nailing versus locked plate for treating supracondylar periprosthetic femur fractures. Orthopedics 36:e561–e566. https://doi.org/10.3928/01477447-20130426-16

    Article  PubMed  Google Scholar 

  6. Ebraheim NA, Kelley LH, Liu X et al (2015) Periprosthetic distal femur fracture after total knee arthroplasty: a systematic review. Orthop Surg 7:297–305. https://doi.org/10.1111/os.12199

    Article  PubMed  PubMed Central  Google Scholar 

  7. Felix NA, Stuart MJ, Hanssen AD (1997) Periprosthetic fractures of the tibia associated with total knee arthroplasty. Clin Orthop Relat Res 345:113–124

    Article  Google Scholar 

  8. Rorabeck CH, Taylor JW (1999) Periprosthetic fractures of the femur complicating total knee arthroplasty. Orthop Clin North Am 30:265–277

    Article  CAS  Google Scholar 

  9. Welch T, Iorio R, Marcantonio AJ et al (2016) Incidence of distal femoral periprosthetic fractures after total knee arthroplasty. Bull Hosp Joint Dis 74:287–292

    Google Scholar 

  10. Berry DJ (1999) Epidemiology: hip and knee. Orthop Clin North Am 30:183–190

    Article  CAS  Google Scholar 

  11. Lizaur-Utrilla A, Miralles-Muñoz FA, Sanz-Reig J (2013) Functional outcome of total knee arthroplasty after periprosthetic distal femoral fracture. J Arthroplasty 28:1585–1588. https://doi.org/10.1016/j.arth.2013.03.007

    Article  PubMed  Google Scholar 

  12. Healy WL, Siliski JM, Incavo SJ (1993) Operative treatment of distal femoral fractures proximal to total knee replacements. J Bone Joint Surg Am 75:27–34

    Article  CAS  Google Scholar 

  13. Lesh ML, Schneider DJ, Deol G et al (2000) The consequences of anterior femoral notching in total knee arthroplasty. A biomechanical study. J Bone Joint Surg Am 82-A:1096–1101

    Article  Google Scholar 

  14. Platzer P, Schuster R, Aldrian S et al (2010) Management and outcome of periprosthetic fractures after total knee arthroplasty. J Trauma 68:1464–1470. https://doi.org/10.1097/TA.0b013e3181d53f81

    Article  PubMed  Google Scholar 

  15. Ritter MA, Thong AE, Keating EM et al (2005) The effect of femoral notching during total knee arthroplasty on the prevalence of postoperative femoral fractures and on clinical outcome. J Bone Joint Surg Am 87:2411–2414. https://doi.org/10.2106/JBJS.D.02468

    Article  PubMed  Google Scholar 

  16. Neer CS, Grantham SA, Shelton ML (1967) Supracondylar fracture of the adult femur. A study of one hundred and ten cases. J Bone Joint Surg Am 49:591–613

    Article  Google Scholar 

  17. Su ET, Kubiak EN, Dewal H et al (2006) A proposed classification of supracondylar femur fractures above total knee arthroplasties. J Arthroplasty 21:405–408. https://doi.org/10.1016/j.arth.2005.05.022

    Article  PubMed  Google Scholar 

  18. Rorabeck CH, Taylor JW (1999) Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin North Am 30:209–214

    Article  CAS  Google Scholar 

  19. Sochart DH, Hardinge K (1997) Nonsurgical management of supracondylar fracture above total knee arthroplasty. Still the nineties option. J Arthroplasty 12:830–834

    Article  CAS  Google Scholar 

  20. Chen F, Mont MA, Bachner RS (1994) Management of ipsilateral supracondylar femur fractures following total knee arthroplasty. J Arthroplasty 9:521–526

    Article  CAS  Google Scholar 

  21. Moran MC, Brick GW, Sledge CB et al (1996) Supracondylar femoral fracture following total knee arthroplasty. Clin Orthop Relat Res 324:196–209

    Article  Google Scholar 

  22. Herrera DA, Kregor PJ, Cole PA et al (2008) Treatment of acute distal femur fractures above a total knee arthroplasty: systematic review of 415 cases (1981–2006). Acta Orthop 79:22–27. https://doi.org/10.1080/17453670710014716

    Article  PubMed  Google Scholar 

  23. Ristevski B, Nauth A, Williams DS et al (2014) Systematic review of the treatment of periprosthetic distal femur fractures. J Orthop Trauma 28:307–312. https://doi.org/10.1097/BOT.0000000000000002

    Article  PubMed  Google Scholar 

  24. Streubel PN, Gardner MJ, Morshed S et al (2010) Are extreme distal periprosthetic supracondylar fractures of the femur too distal to fix using a lateral locked plate? J Bone Joint Surg Br 92:527–534. https://doi.org/10.1302/0301-620X.92B3.22996

    Article  CAS  PubMed  Google Scholar 

  25. Figgie MP, Goldberg VM, Figgie HE, Sobel M (1990) The results of treatment of supracondylar fracture above total knee arthroplasty. J Arthroplasty 5:267–276

    Article  CAS  Google Scholar 

  26. Ricci WM, Loftus T, Cox C, Borrelli J (2006) Locked plates combined with minimally invasive insertion technique for the treatment of periprosthetic supracondylar femur fractures above a total knee arthroplasty. J Orthop Trauma 20:190–196. https://doi.org/10.1097/00005131-200603000-00005

    Article  PubMed  Google Scholar 

  27. Large TM, Kellam JF, Bosse MJ et al (2008) Locked plating of supracondylar periprosthetic femur fractures. J Arthroplasty 23:115–120. https://doi.org/10.1016/j.arth.2008.04.021

    Article  PubMed  Google Scholar 

  28. Ebraheim NA, Liu J, Hashmi SZ et al (2012) High complication rate in locking plate fixation of lower periprosthetic distal femur fractures in patients with total knee arthroplasties. J Arthroplasty 27:809–813. https://doi.org/10.1016/j.arth.2011.08.007

    Article  PubMed  Google Scholar 

  29. Althausen P, Lee M, Finkemeier C et al (2003) Operative stabilization of supracondylar femur fractures above total knee arthroplasty* 1: a comparison of four treatment methods. J Arthroplasty 18:834–839. https://doi.org/10.1054/S0883-5403(03)00339-5

    Article  PubMed  Google Scholar 

  30. McLaren AC, Dupont JA, Schroeber DC (1994) Open reduction internal fixation of supracondylar fractures above total knee arthroplasties using the intramedullary supracondylar rod. Clin Orthop Relat Res 302:194–198

    Google Scholar 

  31. Currall VA, Kulkarni M, Harries WJ (2007) Retrograde nailing for supracondylar fracture around total knee replacement: a compatibility study using the Trigen supracondylar nail. Knee 14:208–211. https://doi.org/10.1016/j.knee.2006.12.001

    Article  CAS  PubMed  Google Scholar 

  32. Kolb W, Guhlmann H, Windisch C et al (2010) Fixation of periprosthetic femur fractures above total knee arthroplasty with the less invasive stabilization system: a midterm follow-up study. J Trauma 69:670–676. https://doi.org/10.1097/TA.0b013e3181c9ba3b

    Article  PubMed  Google Scholar 

  33. Bezwada HP, Neubauer P, Baker J et al (2004) Periprosthetic supracondylar femur fractures following total knee arthroplasty. J Arthroplasty 19:453–458. https://doi.org/10.1016/j.arth.2003.12.078

    Article  PubMed  Google Scholar 

  34. Lee SS, Lim SJ, Moon YW, Seo JG (2014) Outcomes of long retrograde intramedullary nailing for periprosthetic supracondylar femoral fractures following total knee arthroplasty. Arch Orthop Trauma Surg 134:47–52. https://doi.org/10.1007/s00402-013-1890-7

    Article  PubMed  Google Scholar 

  35. Han H-S, Oh K-W, Kang S-B (2005) Retrograde intramedullary nailing for periprosthetic supracondylar fractures of the femur after total knee arthroplasty. Clin Orthop Surg. https://doi.org/10.4055/cios.2009.1.4.201

    Article  Google Scholar 

  36. Gliatis J, Megas P, Panagiotopoulos E, Lambiris E (2005) Midterm results of treatment with a retrograde nail for supracondylar periprosthetic fractures of the femur following total knee arthroplasty. J Orthop Trauma 19:164–170. https://doi.org/10.1097/00005131-200503000-00003

    Article  PubMed  Google Scholar 

  37. Saidi K, Ben-Lulu O, Tsuji M et al (2014) Supracondylar periprosthetic fractures of the knee in the elderly patients: a comparison of treatment using allograft-implant composites, standard revision components, distal femoral replacement prosthesis. J Arthroplasty 29:110–114. https://doi.org/10.1016/j.arth.2013.04.012

    Article  PubMed  Google Scholar 

  38. Mortazavi SMJ, Kurd MF, Bender B et al (2010) Distal femoral arthroplasty for the treatment of periprosthetic fractures after total knee arthroplasty. J Arthroplasty 25:755–780. https://doi.org/10.1016/j.arth.2009.05.024

    Article  Google Scholar 

  39. Cannon SR (2015) The use of megaprosthesis in the treatment of periprosthetic knee fractures. Int Orthop 39:1945–1950. https://doi.org/10.1007/s00264-015-2969-2

    Article  PubMed  Google Scholar 

  40. Windhager R, Schreiner M, Staats K, Apprich S (2016) Megaprostheses in the treatment of periprosthetic fractures of the knee joint: indication, technique, results and review of literature. Int Orthop 40:935–943. https://doi.org/10.1007/s00264-015-2991-4

    Article  PubMed  Google Scholar 

  41. Chen AF, Choi LE, Colman MW et al (2013) Primary versus secondary distal femoral arthroplasty for treatment of total knee arthroplasty periprosthetic femur fractures. J Arthroplasty 28:1580–1584. https://doi.org/10.1016/j.arth.2013.02.030

    Article  CAS  PubMed  Google Scholar 

  42. Parvizi J, Jain N, Schmidt AH (2008) Periprosthetic knee fractures. J Orthop Trauma 22:663–671. https://doi.org/10.1097/BOT.0b013e31816ed989

    Article  PubMed  Google Scholar 

  43. Chalidis BE, Tsiridis E, Tragas AA et al (2007) Management of periprosthetic patellar fractures. A systematic review of literature. Injury 38:714–724. https://doi.org/10.1016/j.injury.2007.02.054

    Article  PubMed  Google Scholar 

  44. Ortiguera CJ, Berry DJ (2002) Patellar fracture after total knee arthroplasty. J Bone Joint Surg Am 84-A:532–540

    Article  Google Scholar 

  45. Windsor RE, Scuderi GR, Insall JN (1989) Patellar fractures in total knee arthroplasty. J Arthroplasty 4(Suppl):S63–S67

    Article  Google Scholar 

  46. Boyd AD, Ewald FC, Thomas WH et al (1993) Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am 75:674–681

    Article  Google Scholar 

  47. Ritter MA, Herbst SA, Keating EM et al (1996) Patellofemoral complications following total knee arthroplasty. Effect of a lateral release and sacrifice of the superior lateral geniculate artery. J Arthroplasty 11:368–372

    Article  CAS  Google Scholar 

  48. Rosenberg AG, Andriacchi TP, Barden R, Galante JO (1988) Patellar component failure in cementless total knee arthroplasty. Clin Orthop Relat Res 236:106–114

    Google Scholar 

  49. Doolittle KH, Turner RH (1988) Patellofemoral problems following total knee arthroplasty. Orthop Rev 17:696–702

    PubMed  Google Scholar 

  50. Aglietti P, Buzzi R, Gaudenzi A (1988) Patellofemoral functional results and complications with the posterior stabilized total condylar knee prosthesis. J Arthroplasty 3:17–25

    Article  CAS  Google Scholar 

  51. Roffman M, Hirsh DM, Mendes DG (1980) Fracture of the resurfaced patella in total knee replacement. Clin Orthop Relat Res 148:112–116

    Google Scholar 

  52. Larson CM, McDowell CM, Lachiewicz PF (2001) One-peg versus three-peg patella component fixation in total knee arthroplasty. Clin Orthop Relat Res 392:94–100

    Article  Google Scholar 

  53. Agarwal S, Sharma RK, Jain JK (2014) Periprosthetic fractures after total knee arthroplasty. J Orthop Surg (Hong Kong) 22:24–29

    Article  Google Scholar 

  54. Brown NM, Murray T, Sporer SM et al (2015) Extensor mechanism allograft reconstruction for extensor mechanism failure following total knee arthroplasty. J Bone Joint Surg Am 97:279–283. https://doi.org/10.2106/JBJS.N.00759

    Article  PubMed  Google Scholar 

  55. Lim CT, Amanatullah DF, Huddleston JI et al (2017) Reconstruction of disrupted extensor mechanism after total knee arthroplasty. J Arthroplasty 32:3134–3140. https://doi.org/10.1016/j.arth.2017.05.005

    Article  CAS  PubMed  Google Scholar 

  56. Ricciardi BF, Oi K, Trivellas M et al (2017) Survivorship of extensor mechanism allograft reconstruction after total knee arthroplasty. J Arthroplasty 32:183–188. https://doi.org/10.1016/j.arth.2016.06.031

    Article  PubMed  Google Scholar 

  57. Siljander M, Gandhi S, Koueiter DM, Wiater PJ (2017) Osteosynthesis of a periprosthetic patella fracture with a locked mesh plate. Int J Orthop 4:811–813

    Article  Google Scholar 

  58. Maniar RN, Nayak RM, Vatchha S, Singhi T (2013) Periprosthetic patellar fracture fixation using suture anchors. Orthopedics 36:e1470–e1473. https://doi.org/10.3928/01477447-20131021-36

    Article  PubMed  Google Scholar 

  59. Hozack WJ, Goll SR, Lotke PA et al (1988) The treatment of patellar fractures after total knee arthroplasty. Clin Orthop Relat Res 236:123–127

    Google Scholar 

  60. Keating EM, Haas G, Meding JB (2003) Patella fracture after post total knee replacements. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000092992.90435.20

    Article  PubMed  Google Scholar 

  61. Parvizi J, Kim K-I, Oliashirazi A et al (2006) Periprosthetic patellar fractures. Clin Orthop Relat Res 446:161–166. https://doi.org/10.1097/01.blo.0000218722.83601.18

    Article  PubMed  Google Scholar 

  62. Chang MA, Rand JA, Trousdale RT (2005) Patellectomy after total knee arthroplasty. Clin Orthop Relat Res 440:175–177

    Article  Google Scholar 

  63. Alden KJ, Duncan WH, Trousdale RT et al (2010) Intraoperative fracture during primary total knee arthroplasty. Clin Orthop Relat Res 468:90–95. https://doi.org/10.1007/s11999-009-0876-9

    Article  PubMed  Google Scholar 

  64. Ebraheim NA, Ray JR, Wandtke ME et al (2015) Systematic review of periprosthetic tibia fracture after total knee arthroplasties. World J Orthop 6:649–654. https://doi.org/10.5312/wjo.v6.i8.649

    Article  PubMed  PubMed Central  Google Scholar 

  65. Cipriano CA, Brown NM, Della Valle CJ et al (2013) Intra-operative periprosthetic fractures associated with press fit stems in revision total knee arthroplasty: incidence, management, and outcomes. J Arthroplasty 28:1310–1313. https://doi.org/10.1016/j.arth.2012.10.003

    Article  PubMed  Google Scholar 

  66. Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59:77–79

    Article  CAS  Google Scholar 

  67. Kim H-J, Park K-C, Kim J-W et al (2017) Successful outcome with minimally invasive plate osteosynthesis for periprosthetic tibial fracture after total knee arthroplasty. Orthop Traumatol Surg Res 103:263–268. https://doi.org/10.1016/J.OTSR.2016.10.007

    Article  PubMed  Google Scholar 

  68. Banim RH, Fletcher M, Warren P (2000) Use of a Dall-Miles plate and cables for the fixation of a periprosthetic tibial fracture. J Arthroplasty 15:131–133

    Article  CAS  Google Scholar 

  69. Assayag MJ, Bor N, Rubin G, Rozbruch SR (2018) Circular hexapod external fixation for periprosthetic tibial fracture. Arthroplast Today 4:192–199. https://doi.org/10.1016/j.artd.2017.03.001

    Article  PubMed  Google Scholar 

  70. Haller JM, Kubiak EN, Spiguel A et al (2014) Intramedullary nailing of tibial shaft fractures distal to total knee arthroplasty. J Orthop Trauma 28:e296–e300. https://doi.org/10.1097/BOT.0000000000000096

    Article  PubMed  Google Scholar 

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  1. Department of Orthopaedic Surgery, Beaumont Health, 3535 W 13. Mile Road, Suite 744, Royal Oak, MI, 48073, USA

    D. J. Lombardo, M. P. Siljander, A. Sobh, D. D. Moore & M. S. Karadsheh

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  2. M. P. Siljander
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  3. A. Sobh
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Lombardo, D.J., Siljander, M.P., Sobh, A. et al. Periprosthetic fractures about total knee arthroplasty. Musculoskelet Surg 104, 135–143 (2020). https://doi.org/10.1007/s12306-019-00628-9

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