Three Hundred Periprosthetic Tibial Fractures Around a Total Knee Replacement: Classification and Outcomes from a Single Institution.

The Journal of Bone & Joint Surgery Pub Date : 2025-05-23 DOI:10.2106/jbjs.24.01407

Evan M Dugdale,Thomas D Alter,Michael J Stuart,Stephen A Sems,Brandon J Yuan,Mark J Spangehl,Bryan D Springer,Daniel J Berry,Matthew P Abdel

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Abstract

BACKGROUND Periprosthetic tibial fractures around a total knee replacement (TKR) remain challenging to manage, with little published information for guidance. The purpose of this study was to review the types, management techniques, and outcomes of periprosthetic tibial fractures in the largest series to date. METHODS We identified 300 periprosthetic tibial fractures (285 patients) around a TKR (43% in primary TKRs and 57% in revision TKRs) sustained between 1996 and 2020. Fractures were classified according to Felix et al. as Type I (tibial plateau), Type II (adjacent to stem), Type III (distal to stem), or Type IV (tibial tubercle), with subtypes A (well-fixed component), B (loose component), and C (intraoperative fracture). Of the fractures in this study, 53% were Type I, 24% were Type II, 16% were Type III, and 8% were Type IV. A total of 46% of fractures occurred intraoperatively, and 54% of fractures occurred postoperatively (61% subtype A, 39% subtype B). The mean patient age at fracture was 67 years, and 64% of patients were female. The mean follow-up was 6 years. RESULTS The intraoperative fracture incidence was 1.40% in revision TKRs and 0.10% in primary TKRs. Among intraoperative fractures, the 2-year survivorship free from tibial component revision was highest in Type I (100%) and lowest in Type IV (67%) (p < 0.001). For postoperative fractures, the 2-year survivorship free from any reoperation was 29% and the 2-year survivorship free from tibial component revision was 51%. Type-I postoperative fractures had the lowest 2-year survivorship free from tibial component revision (10%), whereas Type-III fractures had the highest survivorship (88%) (p < 0.001). CONCLUSIONS Intraoperative periprosthetic fracture of the tibia was fourteenfold more likely in revision TKRs compared with primary TKRs. Among all intraoperative fractures, Type-I fractures were well-tolerated, with 100% survivorship free from tibial component revision at 2 years. Conversely, Type-I postoperative fractures had only 10% survivorship at 2 years. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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全膝关节置换术周围300例胫骨假体周围骨折：来自单一机构的分类和结果。

背景：全膝关节置换术（TKR）周围胫骨假体周围骨折的处理仍然具有挑战性，几乎没有发表的指导信息。本研究的目的是回顾迄今为止最大的系列胫骨假体周围骨折的类型、治疗技术和结果。方法：我们确定了1996年至2020年间在TKR周围发生的300例胫骨假体周围骨折（285例）（43%为原发性TKR， 57%为改良TKR）。根据Felix等人的研究，骨折分为I型（胫骨平台）、II型（胫骨干附近）、III型（胫骨干远端）或IV型（胫骨结节），其中亚型为A型（固定良好的构件）、B型（松散的构件）和C型（术中骨折）。在本研究的骨折中，I型占53%，II型占24%，III型占16%，IV型占8%。术中骨折发生率为46%，术后骨折发生率为54%（61%为A型，39%为B型）。骨折患者的平均年龄为67岁，其中64%为女性。平均随访时间为6年。结果术中骨折发生率在改良TKRs组为1.40%，在原发性TKRs组为0.10%。术中骨折中，无胫骨假体翻修的2年生存率在I型骨折中最高（100%），在IV型骨折中最低（67%）（p < 0.001）。对于术后骨折，2年无再手术生存率为29%，2年无胫骨假体翻修生存率为51%。i型骨折术后2年生存率最低（10%），而iii型骨折术后2年生存率最高（88%）（p < 0.001）。结论改良TKRs术中胫骨假体周围骨折的发生率是原始TKRs的14倍。在所有术中骨折中，i型骨折耐受性良好，2年生存率为100%，无需胫骨假体翻修。相反，i型骨折术后2年生存率仅为10%。证据水平：治疗性三级。有关证据水平的完整描述，请参见作者说明。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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The Journal of Bone & Joint Surgery

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