Intraoperative Fractures Sustained During Total Knee Arthroplasty

Author:

Siddiqi Ahmed12ORCID,Ahmed Afaaq3ORCID,Pasqualini Ignacio4ORCID,Molloy Robert M.4ORCID,Krebs Viktor E.4,Piuzzi Nicolas S.45ORCID

Affiliation:

1. Orthopedic Institute Brielle Orthopedics, a Division of Ortho NJ, Manasquan, New Jersey

2. Department of Orthopedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey

3. Kentucky College of Osteopathic Medicine, Pikeville, Kentucky

4. Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio

5. Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio

Abstract

» While the occurrence of postoperative periprosthetic fractures around total knee arthroplasties (TKAs) are well reported, little is known about intraoperative fractures that occur during TKA. Intraoperative fractures during TKA can occur in femur, tibia, or patella. It is a rare complication with an incidence of 0.2% to 4.4%.» Risk factors of periprosthetic fractures include osteoporosis, anterior cortical notching, chronic corticosteroid use, advanced age, female sex, neurologic disorders, and surgical technique.» Fractures can potentially occur at any stage of the TKA including exposure, bone preparation, placement of trial components, cementation, insertion of the final components, and seating of the polyethylene insert. Forced flexion during trialing increases the risk for patella fracture, tibial plateau, or tubercle fractures especially when there is under resection of the bone.» Management guidelines for these fractures are lacking with current options being observation, internal fixation, the use of stems and augments, increasing constraint of the prosthesis, implant revision, and modifying the postoperative rehabilitation.» Finally, the outcomes of intraoperative fractures are not well reported in the literature.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Orthopedics and Sports Medicine,Surgery

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