Abstract
Partial knee arthroplasty is a procedure with long-term successful outcomes. However,
there are several potential complications including retained cement fragments, bearing
dislocation, infection, component loosening, medial collateral ligament injury, and
overcorrection, leading to progressive arthritis. Periprosthetic fracture is an uncommon
complication, with multiple reports showing an incidence of less than 1%. Hence, there
are no established algorithms to guide treatment. A consecutive series of 2,464 patients
who underwent partial knee arthroplasty between January 2009 and April 2017 was reviewed.
We identified 16 patients with early periprosthetic fracture, with an incidence of
0.6%. All of these were tibial fractures, which occurred at a mean of 35 days postoperatively.
There were 5 males and 11 females, with an average age of 70 years at the time of
surgery. Average follow-up was 62 months. Two patients had contralateral compartment
insufficiency fractures that were successfully treated nonoperatively, five patients
immediately underwent total knee arthroplasty (TKA), and nine patients underwent open
reduction internal fixation (ORIF). Two of these cases had a failed ORIF and required
conversion to TKA. Seven patients were successfully treated with a medial buttress
plate in compression. Average Knee Society Score at final follow-up was 81, and average
flexion was 115 degrees, with no patients having greater than 5-degree flexion contracture.
Periprosthetic fracture following partial knee arthroplasty resulted in a high rate
of conversion TKA. However, ORIF in select patients resulted in fracture healing and
retention of the partial knee replacement. All patients were successfully treated
with low complication rates, excellent range of motion, and acceptable knee scores
at final follow-up.
Keywords
unicompartmental knee arthroplasty - periprosthetic fracture - complications - trauma
