Intra-operative fractures in primary total knee arthroplasty - a systematic review
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Background: One of the rare complications of primary total knee arthroplasty is intra-operative fracture. Intraoperative fracture during revision knee arthroplasty has been well-documented but there is limited literature on fractures occurring during primary knee arthroplasty. We conducted a systematic review of the literature to compare and contrast the various studies to clearly define the predisposing factors, incidence, and characteristics of the fracture itself and to arrive at a consensus on the management and prevention of intra-operative fractures during primary knee arthroplasty. Methods: The PubMed/Medline, Cochrane, Scopus and Embase databases were searched using keywords “intraoperative fracture”, “distal femoral fracture”, “tibial fracture”, “patella fracture” and “primary total knee arthroplasty”. A total of 158 articles were retrieved and after further filtration and exclusion processing, 10 articles that evaluated intra-operative fractures in primary total knee arthroplasty were included for the review. Results: The reported incidence of intra-operative fractures varied from 0.2% to 4.4%. A higher incidence in female patients with a male to female ratio of 0.4 was reported. Posterior stabilized (PS) total knee arthroplasty was associated with higher risk of intra-operative femoral fractures by many authors in this review. Timing of occurrence and location of the intra-operative fractures can vary widely, with femoral fractures occurring more commonly during bone preparation, trialing and impaction of the final implant and tibial fractures occurring during preparation for the tibial keel and impaction of the tibial component. Conclusions: Intra-operative fractures during primary total knee arthroplasty are rare with higher risk associated with osteoporosis, rheumatoid arthritis, advanced age, female gender, chronic steroid use, metabolic bone disorders, PS type of femoral implant and difficult surgical exposure of the knee joint due to severe deformities. A plethora of management options have been utilized according to surgeon preference. Standard principles of fracture fixation and arthroplasty principles should be followed to achieve stable internal fixation and any unstable fracture site should be bypassed with the utilization of stemmed components. Satisfactory radiographic and functional outcome can be expected with appropriate treatment.
Abstract
Background: One of the rare complications of primary total knee arthroplasty is intra-operative fracture. Intraoperative fracture during revision knee arthroplasty has been well-documented but there is limited literature on fractures occurring during primary knee arthroplasty. We conducted a systematic review of the literature to compare and contrast the various studies to clearly define the predisposing factors, incidence, and characteristics of the fracture itself and to arrive at a consensus on the management and prevention of intra-operative fractures during primary knee arthroplasty. Methods: The PubMed/Medline, Cochrane, Scopus and Embase databases were searched using keywords “intraoperative fracture”, “distal femoral fracture”, “tibial fracture”, “patella fracture” and “primary total knee arthroplasty”. A total of 158 articles were retrieved and after further filtration and exclusion processing, 10 articles that evaluated intra-operative fractures in primary total knee arthroplasty were included for the review. Results: The reported incidence of intra-operative fractures varied from 0.2% to 4.4%. A higher incidence in female patients with a male to female ratio of 0.4 was reported. Posterior stabilized (PS) total knee arthroplasty was associated with higher risk of intra-operative femoral fractures by many authors in this review. Timing of occurrence and location of the intra-operative fractures can vary widely, with femoral fractures occurring more commonly during bone preparation, trialing and impaction of the final implant and tibial fractures occurring during preparation for the tibial keel and impaction of the tibial component. Conclusions: Intra-operative fractures during primary total knee arthroplasty are rare with higher risk associated with osteoporosis, rheumatoid arthritis, advanced age, female gender, chronic steroid use, metabolic bone disorders, PS type of femoral implant and difficult surgical exposure of the knee joint due to severe deformities. A plethora of management options have been utilized according to surgeon preference. Standard principles of fracture fixation and arthroplasty principles should be followed to achieve stable internal fixation and any unstable fracture site should be bypassed with the utilization of stemmed components. Satisfactory radiographic and functional outcome can be expected with appropriate treatment.
참고문헌 (20)
- Kurtz S, "Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030", J Bone Joint Surg Am, 89, pp.780~785 (2007)[DOI]
- Alden KJ, "Intraoperative fracture during primary total knee arthroplasty", Clin Orthop Relat Res, 468, pp.90~95 (2010)[DOI]
- A. Pinaroli, "Intraoperative fractures and ligament tears during total knee arthroplasty. A 1795 posterostabilized TKA continuous series", Orthopaedics & Traumatology: Surgery & Research, 95(3), pp.183~189 (2009), Elsevier BV[DOI]
- Agarwala S, "Intra-operative fractures in primary total knee arthroplasty", J Clin Orthop Trauma, 10, pp.571~575 (2019)[DOI]
- Pun AH, "Intra-operative fracture in posteriorstabilised total knee arthroplasty", J Orthop Surg(Hong Kong), 23, pp.205~208 (2015)[DOI]
- Ze-yu Huang, "Intraoperative Femoral Condylar Fracture during Primary Total Knee Arthroplasty: Report of Two Cases", Orthopaedic Surgery, 7(2), pp.180~184 (2015), Wiley[DOI]
- Lawrence A Delasotta, "Distal Femoral Fracture during Primary Total Knee Arthroplasty", Journal of Orthopaedic Surgery, 23(2), pp.202~204 (2015), SAGE Publications[DOI]
- P. Hernigou, "Facteurs du risque de fracture du fémur distal dans les prothèses totales du genou", Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 92(2), pp.140~147 (2006), Elsevier BV[DOI]
- Felix NA, "Periprosthetic fractures of the tibia associated with total knee arthroplasty", Clin Orthop Relat Res, 345, pp.113~124 (1997)
- Michael J. Stuart, "TOTAL KNEE ARTHROPLASTY", Orthopedic Clinics of North America, 30(2), pp.279~286 (1999), Elsevier BV[DOI]
- Kim KI, "Periprosthetic fractures after total knee arthroplasties", Clin Orthop Relat Res, 446, pp.167~175 (2006)[DOI]
- Berry DJ, "Epidemiology: hip and knee", Orthop Clin North Am, 30, pp.183~190 (1999)[DOI]
- Adolph V. Lombardi, "Intercondylar distal femoral fracture", The Journal of Arthroplasty, 10(5), pp.643~650 (1995), Elsevier BV[DOI]
- Gelinas JJ, "Treatment of an intraoperative patellar fracture during revision total knee arthroplasty", J Arthroplast, 17, pp.1066~1069 (2002)[DOI]
- Adam A. Sassoon, "Intraoperative Fracture During Aseptic Revision Total Knee Arthroplasty", The Journal of Arthroplasty, 29(11), pp.2187~2191 (2014), Elsevier BV[DOI]
- Fares S. Haddad, "THE PREVENTION OF PERIPROSTHETIC FRACTURES IN TOTAL HIP AND KNEE ARTHROPLASTY", Orthopedic Clinics of North America, 30(2), pp.191~207 (1999), Elsevier BV[DOI]
- Engh GA, "Periprosthetic fractures adjacent to total knee implants: treatment and clinical results", Instr Course Lect, 47, pp.437~448 (1998)
- Pier Francesco Indelli, "Primary posterior stabilized total knee arthroplasty: analysis of different instrumentation", Journal of Orthopaedic Surgery and Research, 9(1) (2014), Springer Science and Business Media LLC[DOI]
- Bozkurt M, "Total and intercondylar notch bone resection in posterior stabilized knee arthroplasty : analysis of five manufacturer designs", Knee Surg Sports Traumatol Arthrosc, 25, pp.1731~1735 (2017)[DOI]
- Gemayel A, "Distal femoral replacement following an intraoperative periprosthetic fracture in a patient with prior bone mulch ACL reconstruction", Case Rep Orthop, 2019, pp.6213807~ (2019)[DOI]