Treatment of periprosthetic fractures following TKA

Bae, Dae Kyung; Yim, Chang Moo; Kim, Jin Moon

Abstract

PURPOSE
To evaluate the clinical and radiological results of periprosthetic fracture treatments following total knee arthroplasty (TKA) .
MATERIALS AND METHODS
Between Jan. 1991 and Jun. 1998, 16 knees in 15 patients were treated for periprosthetic fractures following TKA. Average age of the patients were 56 years (26-69 years) , and 14 patients were women and one was a man. The average follow-up period after fracture was 2 years 5 months (1 year - 8 years 2 months) . We analyzed clinical results according to the knee rating score of Hospital for Special Surgery (HSS) , bony union time and femorotibial angle.
RESULTS
Among 980 knees in 633 patients with primary total knee arthroplasty, 16 knees in 15 patients developed periprosthetic fractures. The incidence was 1.6%. Three knees were treated with closed reduction and cast immobilization, seven knees were treated with Ender nailing, and six knees were treated with open reduction and internal fixation. Range of motion was 113 degrees on an average before fracture and 94 degrees at the last follow up, and HSS knee rating score averaged 88 points before fracture and 83 points at the last follow up. Radiologically, 15 knees had complete union and one knee had nonunion.
CONCLUSION
The authors think that conservative management was not effective due to prolonged immobilization and late start of ROM exercise. Open reduction with internal fixations provided a better reduction of the fracture, preserving the alignment of fragment and restoring function. Also, Ender nailing was an alternative option of treatment considering less morbidity and satisfactory functional results.