Tibia periprosthetic fracture management – A 30-year systematic review

Periprosthetic fractures are demanding and though uncommon, tibial periprosthetic fractures are furtherly destined to impact clinical and surgical orthopaedics due to the increasing number of arthroplasties performed yearly.

Systematic research focusing on periprosthetic tibia fractures reported beginning 1990 until 2022 was conducted on the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed, Embase, Scopus, the Science Citation Index Expanded from Web of Science, ScienceDirect, CINAHL, and LILACS.

A total of 473 records resulted from the research. Following the exclusion process the studies included were twenty-three (23) with a total of 287 patients and 357 treatments. Periprosthetic tibial fractures prevail in women (72.1 %), in the obese and in rheumatoid arthritis affected patients.

Treatments consist of conservative treatments (22.7 %), osteosynthesis (16.5 %), revision total knee arthroplasty (23.0 %), intramedullary nailing (2.5 %) and other treatments (30.8 %). Stable fractures are treated in various methods, unstable fractures are mainly treated through revision total knee arthroplasty and intraoperative fractures are treated both conservatively and operatively.

Periprosthetic tibial fractures are destined to heavily burden orthopaedics traumatology. Periprosthetic tibia fractures are complex and commonly afflict obese and elderly women with history of rheumatoid arthritis. These fractures may be managed following the ASAP algorithm. Stable fractures are treated using different methods and unstable fractures are mainly approached through revision total knee arthroplasty prior to other treatments. Intraoperative fractures are treated both conservatively and surgically.