Download PDF
Z Orthop Unfall 2012; 150(05): e143-e154
DOI: 10.1055/s-0032-1315398
Refresher Orthopädie und Unfallchirurgie
Georg Thieme Verlag KG Stuttgart · New York

Periprothetische Frakturen des Kniegelenks

Periprosthetic Fractures of the Knee Joint
M. Fehringer
BG Klinik, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen
,
M. Münzberg
BG Klinik, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen
,
P. A. Grützner
BG Klinik, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen
,
J. Franke
BG Klinik, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen
› Author Affiliations
Further Information

Publication History

Publication Date:
18 October 2012 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

In Anbetracht der demografischen Entwicklung und bei steigenden Implantationszahlen von Endoprothesen sind periprothetische Frakturen ein zunehmendes Problem. Im Bereich des Kniegelenks treten die meisten dieser Frakturen postoperativ nach einem Zeitraum von 2–4 Jahren auf. Ursache können Traumata, implantationsspezifische Faktoren und Prothesenlockerungen sein. Neben weiteren Risikofaktoren sind vor allem Osteopenie und ein vermindertes Bewegungsausmaß der Prothese zu nennen. Frakturklassifikationen, welche in der Frakturbeschreibung auch eine Lockerung der Prothese mit einbeziehen, sind ein wichtiges Instrument für die Therapieplanung. An Therapieoptionen kommen neben dem konservativen Vorgehen vor allem die operative Frakturstabilisierung oder ein Prothesenwechsel infrage. Die Versorgungsmöglichkeiten periprothetischer Frakturen am Kniegelenk werden unter Berücksichtigung der verschiedenen Ausgangssituationen und mit dem Ziel, eine belastungsstabile Situation für eine frühe Mobilisation zu erreichen, diskutiert.

Abstract

Periprosthetic fractures are a challenging problem in view of the demographic development and the increasing number of implanted prostheses. Most of these fractures occur postoperatively after a period of two to four years after implantation of a total knee arthroplasty. They are usually caused by traumata, implantation-specific factors and loosening of the prosthesis. Beside further risk factors osteopenia and a reduced mobility of the prosthesis predispose to these fractures. Numerous classifications which also include a loosening of the prosthesis in the fracture discription are an important tool for planning the therapy. Beside the conservative treatment, the stabilization of the fracture or changing the prosthesis should be considered. The treatment options of periprosthetic fractures of the knee joint are discussed in view of different initial situations with the aim of achieving a load-stable situation.

Key words

periprothetische Fraktur - Knietotalendoprothese - Osteopenie - Frakturklassifikatio - Behandlungskonzepte

Key words

periprosthetic fracture - total knee arthroplasty - osteopenia - fracture classification - treatment options

Literaturverzeichnis als PDF

 

  • Literatur

  • 1 Bundesgeschäftsstelle Qualitätssicherung gGmbH – BQS. BQS-Bundesauswertung 2008. Knie-Totalendoprothesen-Erstimplantation. 2009. http://www.bqs-outcome.de/2008/ergebnisse/leistungsbereiche/knie_tep_erst Stand: 15.06.2012
    PubMedGoogle Scholar
  • 2 Kim KI, Egol KA, Hozak WJ et al. Periprosthetic fractures after total knee arthroplasties. Clin Orthop Relat Res 2006; 446: 167-175
    CrossrefPubMedGoogle Scholar
  • 3 Su ET, Hargovind D, Di Cesare P. Periprosthetical femur fractures above total knee replacements. J Am Acad Orthop Surg 2004; 12: 12-20
    PubMedGoogle Scholar
  • 4 Felix NA, Stuart MJ, Hanssen AD. Periprosthetic fractures of the tibia associated with total knee arthroplasty. Clin Orthop Relat Res 1997; 345: 113-124
    PubMedGoogle Scholar
  • 5 Healy WL, Siliski JM, Incavo SJ. Operative treatment of distal femoral fractures proximal to total knee replacements. J Bone Joint Surg Am 1993; 75: 27-34
    PubMedGoogle Scholar
  • 6 Inglis AE, Walker PS. Revision of failed knee replacements using fixed-axis hinges. J Bone Joint Surg Br 1991; 73: 757-761
    PubMedGoogle Scholar
  • 7 Ritter MA, Faris PM, Keating EM. Anterior femoral notching and ipsilateral supracondylar femur fractures in total knee arthroplasty. J Arthroplasty 1988; 3: 185-187
    CrossrefPubMedGoogle Scholar
  • 8 Figgie MP, Goldberg VM, Figgie HE et al. The results of treatment of supracondylar fracture above total knee arthroplasty. J Arthroplasty 1990; 5: 267-276
    CrossrefPubMedGoogle Scholar
  • 9 Merkel KD, Johnson jr. EW. Supracondylar fracture of the femur after total knee arthroplasty. J Bone Joint Surg Am 1986; 68: 29-43
    PubMedGoogle Scholar
  • 10 Chalidis BE, Tsiridis E, Tragas AA et al. Management of periprosthetic patellar fractures: a systematic review of the literature. Injury 2007; 38: 714-724
    CrossrefPubMedGoogle Scholar
  • 11 Ortiguera CJ, Berry DJ. Patellar fracture after total knee arthroplasty. J Bone Joint Surg Am 2002; 84: 532-540
    PubMedGoogle Scholar
  • 12 Grace JN, Sim FH. Fracture of the patella after total knee arthroplasty. Clin Orthop Relat Res 1988; 230: 168-175
    PubMedGoogle Scholar
  • 13 Alden KJ, Duncan WH, Trousdale RT et al. Intraoperative fracture during primary total knee arthroplasty. Clin Orthop Relat Res 2009; 468: 90-95
    PubMedGoogle Scholar
  • 14 McGeaw P, Kumar A. Periprosthetic fractures of the femur after total knee arthroplasty. J Orthop Traumatol 2010; 11: 135-141
    CrossrefPubMedGoogle Scholar
  • 15 Lesh ML, Schneider DJ, Deol G et al. The consequences of anterior notching in total knee arthroplasty: a biomechanical study. J Bone Joint Surg Am 2000; 82: 1096-1101
    PubMedGoogle Scholar
  • 16 Ritter MA, Thong AE, Keating M et al. The effect of femoral notching during total knee arthroplasty on the prevalence of postoperative femoral fractures and on clinical outcome. J Bone Joint Surg Am 2005; 87: 2411-2414
    CrossrefPubMedGoogle Scholar
  • 17 Lotke PA, Ecker ML. Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 1977; 59: 77-79
    PubMedGoogle Scholar
  • 18 Seeger JB, Haas D, Jäger S et al. Extended sagittal saw cut significantly reduces fracture load in cementless unicompartmental knee arthroplasty compared to cemented tibia plateaus: an experimental cadaver study. Knee Surg Sports Traumatol Arthrosc 2012; 20: 1087-1091
    CrossrefPubMedGoogle Scholar
  • 19 Parvizi J, Kim KI, Oliashirazi A et al. Periprosthetic patellar fractures. Clin Orthop Relat Res 2006; 446: 161-166
    CrossrefPubMedGoogle Scholar
  • 20 Nicholls RL, Green D, Kuster MS. Patella interosseous blood flow disturbance during a medial or lateral arthrotomy in total knee arthroplasty: a laser doppler flowmetry study. Knee Surg Sports Traumatol Arthrosc 2006; 14: 411-416
    CrossrefPubMedGoogle Scholar
  • 21 Rorabeck CH, Taylor JW. Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin North Am 1999; 30: 209-214
    CrossrefPubMedGoogle Scholar
  • 22 Goldberg VM, Figgie 3rd HE, Inglis AE et al. Patellar fracture type and prognosis in condylar total knee arthroplasty. Clin Orthop Relat Res 1988; 236: 115-122
    PubMedGoogle Scholar
  • 23 Mittelmeier T, Stockle U, Perka C et al. Periprosthetic fractures after total knee joint arthroplasty. Unfallchirurg 2005; 108: 481-495
    CrossrefPubMedGoogle Scholar
  • 24 Rorabeck CH, Taylor JW. Periprosthetic fractures of the femur complicating total knee arthroplasty. Orthop Clin North Am 1999; 30: 265-277
    CrossrefPubMedGoogle Scholar
  • 25 Althausen PL, Lee MA, Finkemeier CG et al. Operative stabilisation of supracondylar femur fractures above total knee arthroplasty: a comparison of four treatment options. J Arthroplasty 2003; 18: 834-839
    CrossrefPubMedGoogle Scholar
  • 26 Wick M, Muller EJ, Kutscha-Lissberg F et al. Periprosthetic supracondylar femur fractures: LISS or retrograde intramedullary nailing? Problems with the use of minimally invasive technique. Unfallchirurg 2004; 107: 181-188
    CrossrefPubMedGoogle Scholar
  • 27 Haidukewych GJ, Jacofsky DJ, Hanssen AD. Treatment of periprosthetic fractures around a total knee arthroplasty. J Knee Surg 2003; 16: 111-117
    PubMedGoogle Scholar
  • 28 Tharani R, Nakasone C, Vince KG. Periprosthetic fractures after total knee arthroplasty. J Arthroplasty 2005; 20 (Suppl. 02) 27-32
    CrossrefPubMedGoogle Scholar
  • 29 Greene KA, Schurman 2nd JR. Quadriceps muscle function in primary total knee arthroplasty. J Arthroplasty 2008; 23 (Suppl. 07) 15-19
    PubMedGoogle Scholar
  • 30 Silva M, Shepherd EF, Jackson WO et al. Knee strength after total knee arthroplasty. J Arthroplasty 2003; 18: 605-611
    CrossrefPubMedGoogle Scholar
  • 31 Kuster M, Blatter G. Knee joint muscle function after patellectomy: how important are the hamstrings?. Knee Surg Sports Traumatol Arthrosc 1996; 4: 160-163
    CrossrefPubMedGoogle Scholar