J Korean Orthop Assoc.  2010 Aug;45(4):330-333.

Pelvis Insufficiency Fracture after Total Knee Arthroplasty

• Koh HS
• Song ES
• Lee EB

Abstract

Pelvic insufficiency fracture is a very rare complication after total knee arthroplasty (TKA). This fracture occurs in elderly osteoporotic patients, spontaneously or after minor trauma, and its diagnosis can be difficult unless there is a high degree of clinical suspicion. The consequence of missed pelvic insufficiency fracture can be profound: this fracture may progress into an unstable fracture that leads to significant disability. Bone scans assist in the early diagnosis of this fracture. We present a case of osteoporotic pelvic insufficiency fracture after bilateral TKA. A 76 year-old female underwent bilateral TKA for advanced osteoarthritis in her both knees. She also had osteoporosis, and thus we filled an oral bisphosphonate (weekly Risedronate) prescription. Nine months after TKAs, she presented with significant pain around the left buttock and inguinal area without specific trauma. With the use of plain radiographs and a bone scan, a pelvic insufficiency fracture was detected. We successfully treated the patient with conservative management including rest with a pelvic strap, and continued medication for osteoporosis.

Keyword

pelvis; insufficiency fracture; osteoporosis; total knee arthroplasty

MeSH Terms

Aged
Arthroplasty
Buttocks
Early Diagnosis
Female
Fractures, Stress
Humans
Knee
Osteoarthritis
Osteoporosis
Pelvis
Prescriptions

Figure

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  Figure 1 Preoperative lower extremity AP view shows marked osteoarthritis at the medial femorotibial joints and patellofemoral joints of both knees, and disruption of alignment of both knee joints to medial side (genus varus deformity).

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  Figure 2 Pelvis anteroposterior radiograph taken 9 months after the initial total knee arthroplasty shows the fracture of left pubic ramus.

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  Figure 3 Whole body bone scan shows densely increased isotope uptakes at both sacroiliac joint region of sacrum and left pubic bone, suggesting sacrum & left pubic bone insufficient fracture. Mildly increased isotope uptakes are seen at 6th and 7th thoracic spines, suggesting old compression fracture changes.

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  Figure 4 This pelvis anteroposterior radiograph shows sclerotic change and callus formation at previous insufficiency fracture site of left pubic ramus.

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