Georgios Kalifis, Theodorakys Marin Fermin, Angelo V Vasiliadis, Georgios Tsinaslanidis, Christopher Gee, Michael Hantes
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Studies were eligible if they reported tibial PPF in knee arthroplasty with at least three patients, describing the treatment approach and follow-up. Data extracted included patient demographics, fracture classification, treatment method, outcomes and methodological quality.</p><p><strong>Results: </strong>Seventeen studies met the inclusion criteria, including 473 patients with a mean age of 67.6 ± 2.5 years. Felix classification was used for 172 patients, Type 3 being the most common (48%). Overall union rate was 87%. While 29% of fractures were managed conservatively, 71% underwent operative management, with open reduction and internal fixation (ORIF) being the most common at 55%. The complication rate was 38%, with infection being the most common standing at 13%. The secondary intervention rate was 28%, most commonly due to failure of initial management and soft-tissue-related complications.</p><p><strong>Conclusion: </strong>Tibial PPF is a rare but demanding complication of knee arthroplasty, associated with high complication (38%) and reoperation (28%) rates. Optimisation of surgical techniques is crucial to prevent iatrogenic fractures. Provided that the implant is stable, fracture fixation is effective following the appropriate principles depending on the personality of the fracture. Revision TKA may also be effective as a first-line option. Considering the scarce evidence in the literature and the high volume of worldwide knee arthroplasties performed, further high-quality studies are crucial to improve outcomes.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Periprosthetic fractures of the tibia in knee arthroplasty have a high risk of treatment failure: A systematic review.\",\"authors\":\"Georgios Kalifis, Theodorakys Marin Fermin, Angelo V Vasiliadis, Georgios Tsinaslanidis, Christopher Gee, Michael Hantes\",\"doi\":\"10.1002/ksa.12692\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Tibial periprosthetic fractures (PPF) are rare but potentially devastating complications following knee arthroplasty. Despite the increasing number of knee replacements worldwide, there is limited data in the literature regarding these injuries. This systematic review aimed to add up-to-date, evidence-based data on tibial PPF that may lead to a more standardised approach and improved outcomes.</p><p><strong>Methods: </strong>A systematic search of PubMed, Virtual Health Library and Cochrane Library databases was performed in accordance with PRISMA guidelines, including studies published from January 2015 to January 2025. Studies were eligible if they reported tibial PPF in knee arthroplasty with at least three patients, describing the treatment approach and follow-up. Data extracted included patient demographics, fracture classification, treatment method, outcomes and methodological quality.</p><p><strong>Results: </strong>Seventeen studies met the inclusion criteria, including 473 patients with a mean age of 67.6 ± 2.5 years. 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引用次数: 0
摘要
目的：胫骨假体周围骨折（PPF）是膝关节置换术后罕见但具有潜在破坏性的并发症。尽管世界范围内膝关节置换术的数量不断增加，但文献中关于这些损伤的数据有限。本系统综述旨在增加最新的、基于证据的胫骨PPF数据，这可能导致更标准化的方法和改善的结果。方法：按照PRISMA指南系统检索PubMed、Virtual Health Library和Cochrane Library数据库，包括2015年1月至2025年1月发表的研究。如果研究报告了至少3例膝关节置换术患者的胫骨PPF，并描述了治疗方法和随访，则该研究符合条件。提取的数据包括患者人口统计学、骨折分类、治疗方法、结果和方法学质量。结果：17项研究符合纳入标准，共纳入473例患者，平均年龄67.6±2.5岁。172例患者采用Felix分型，3型最常见（48%）。总融合率为87%。29%的骨折采用保守治疗，71%的骨折采用手术治疗，其中切开复位内固定（ORIF）最为常见，占55%。并发症发生率为38%，最常见的感染发生率为13%。二次干预率为28%，最常见的原因是初始治疗失败和软组织相关并发症。结论：胫骨PPF是膝关节置换术中一种罕见的并发症，并发症高（38%），再手术率高（28%）。优化手术技术是预防医源性骨折的关键。只要植入物是稳定的，根据骨折的特点，遵循适当的原则进行骨折固定是有效的。修订TKA作为一线选择也可能有效。考虑到文献证据不足和世界范围内进行的大量膝关节置换术，进一步的高质量研究对于改善结果至关重要。证据等级：四级。
Periprosthetic fractures of the tibia in knee arthroplasty have a high risk of treatment failure: A systematic review.
Purpose: Tibial periprosthetic fractures (PPF) are rare but potentially devastating complications following knee arthroplasty. Despite the increasing number of knee replacements worldwide, there is limited data in the literature regarding these injuries. This systematic review aimed to add up-to-date, evidence-based data on tibial PPF that may lead to a more standardised approach and improved outcomes.
Methods: A systematic search of PubMed, Virtual Health Library and Cochrane Library databases was performed in accordance with PRISMA guidelines, including studies published from January 2015 to January 2025. Studies were eligible if they reported tibial PPF in knee arthroplasty with at least three patients, describing the treatment approach and follow-up. Data extracted included patient demographics, fracture classification, treatment method, outcomes and methodological quality.
Results: Seventeen studies met the inclusion criteria, including 473 patients with a mean age of 67.6 ± 2.5 years. Felix classification was used for 172 patients, Type 3 being the most common (48%). Overall union rate was 87%. While 29% of fractures were managed conservatively, 71% underwent operative management, with open reduction and internal fixation (ORIF) being the most common at 55%. The complication rate was 38%, with infection being the most common standing at 13%. The secondary intervention rate was 28%, most commonly due to failure of initial management and soft-tissue-related complications.
Conclusion: Tibial PPF is a rare but demanding complication of knee arthroplasty, associated with high complication (38%) and reoperation (28%) rates. Optimisation of surgical techniques is crucial to prevent iatrogenic fractures. Provided that the implant is stable, fracture fixation is effective following the appropriate principles depending on the personality of the fracture. Revision TKA may also be effective as a first-line option. Considering the scarce evidence in the literature and the high volume of worldwide knee arthroplasties performed, further high-quality studies are crucial to improve outcomes.
期刊介绍：
Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication.
The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance.
Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards.
Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
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