Stefan Kastalag Risager, Anders Troelsen, Bjarke Viberg, Martin Lindberg-Larsen
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引用次数: 0
Abstract
Background: A periprosthetic tibial fracture (PPTF) is a known complication of medial unicompartmental knee arthroplasty (mUKA). Treatment options include conversion to total knee arthroplasty (cTKA), open reduction internal fixation (ORIF), and nonoperative treatment. The risk of reoperation after initial treatment of PPTFs is not well examined. Given the rise of cementless mUKA and its association with early (≤4 months), likely surgery-related fractures, this group is particularly interesting. The aim of this study was to (1) report the 2-year risk of reoperation according to initial treatment and (2) report the need for delayed conversion to TKA (dcTKA) after ORIF or nonoperative treatment, or the need for revision TKA (rTKA) after cTKA.
Methods: Using data from the Danish Knee Arthroplasty Register and the Danish National Patient Register, all PPTFs after mUKAs between 1997 and 2022 were included and stratified by treatment. Subsequent reoperations and need for dcTKA or rTKA within 2 years were outcomes.
Results: We identified 177 PPTFs after mUKA with complete 2-year follow-up. When the treatment of the PPTF was cTKA (69 cases), 5 cases (7%) underwent reoperation and fewer than 5 required rTKA. For nonoperative treatment (46 cases), 13 cases (28%) underwent reoperation, with 10 cases requiring dcTKA. When treated with ORIF (62 cases), 25 cases (40%) underwent reoperation, with 19 cases requiring dcTKA. PPTFs after cemented mUKA were mostly late PPTFs (70%) and were often treated nonoperatively, where PPTFs after cementless mUKA were often early PPTFs (74-78%) and very rarely treated nonoperatively. Fixation of mUKA was not associated with the risk of reoperation within each treatment group. Among 74 early PPTFs after cementless mUKA, 35 cases were treated with cTKA with fewer than 5 reoperations within 2 years and 0 cases needing rTKA. In contrast after ORIF (39 cases), 16 cases (41%) underwent reoperation, with 12 cases requiring dcTKA.
Conclusion: PPTFs treated with ORIF were associated with higher rates of reoperation and need for dcTKA compared with PPTFs treated with cTKA and nonoperative treatment. These data suggest that careful consideration is needed before using ORIF as treatment. However, the unknown fracture severity precludes definitive attribution of reoperation to the treatments.
Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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