Clin Orthop Surg.  2014 Dec;6(4):484-488. 10.4055/cios.2014.6.4.484.

Autosomal Dominant Type I Osteopetrosis Is Related with Iatrogenic Fractures in Arthroplasty

• van Hove R
• de Jong T
• Nolte PA

• KMID: 1794740
• DOI: http://doi.org/10.4055/cios.2014.6.4.484

Abstract

Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts. ADO poses difficulties during arthroplasty because of the increased chance for iatrogenic fractures due to sclerotic bone. ADO is divided into two types based on radiological findings, fracture risk, and osteoclast activity. These differences suggest less brittle bone in patients with ADO I compared to that of patients with ADO II, which suggests a smaller chance of preoperative fractures during cementless arthroplasty in ADO I compared with that in ADO II. A case of cementless total knee arthroplasty in a patient with ADO I is presented. Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced. Therefore, the differences between ADO I and ADO II may not be clinically relevant for an iatrogenic fracture during arthroplasty in patients with ADO.

Keyword

Osteopetrosis autosomal dominant type I; Cementless total knee replacement; Iatrogenic fractures

MeSH Terms

Acetabulum/injuries
Adult
Arthroplasty, Replacement, Knee/*adverse effects
Down Syndrome/complications
Female
Femoral Fractures/etiology/surgery
Genes, Dominant
Humans
Iatrogenic Disease
Knee Joint/surgery
Osteoarthritis, Knee/complications/*surgery
Osteopetrosis/complications/*surgery
Periprosthetic Fractures/*etiology/surgery
Tibial Fractures/etiology/therapy

Figure

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  Fig. 1 Preoperative radiographs of the right knee. (A) Anteroposterior view showing dense bone, narrowing of the lateral joint space, osteophytes in the lateral and medial plateau, and valgus alignment. (B) Lateral view showing dense bone, osteophytes at the patellofemoral joint and possible loose bodies.

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  Fig. 2 Postoperative radiograph of the right knee. Lateral view shows the cementless mobile-bearing total knee prosthesis and dense bone 1 day after surgery. Arrow points to the fissured fracture that was not visible on the anteroposterior view.

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  Fig. 3 One-year postoperative radiographs of the right knee. Anteroposterior (A) and lateral (B) views show a well positioned cementless total knee prosthesis in dense bone and no signs of the fissured fracture.

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  Fig. 4 Postoperative radiograph of the right hip. Anteroposterior view of the right hip 1 day after resection arthroplasty. The lower arrow indicates the false route in the proximal femur, and the upper arrow indicates the acetabular fracture.

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