Management of periprosthetic fractures of knee arthroplasty with revision surgery.

Objective: As periprosthetic knee fractures are becoming common with the increase in incidence of primary and revision total knee arthroplasty, their management and treatment have become important. The current study aims to evaluate the revision knee arthroplasty carried out due to the failure of primary treatment of periprosthetic femoral fractures.

Methods: The study was conducted from May 2012 to September 2019 at Orthopedics department of Xinjiang Medical University; out of 21 patients 11 were women and 10 men aged 44 to 80 (mean, 70.76 ± 8.31) years who underwent revision surgery for periprosthetic fractures of 19 distal femur, 1 patellar, and 1 proximal tibial fracture. Nineteen cases had definite trauma history leading to periprosthetic fracture, and 2 cases had fracture during post-operative functional exercise. All patients had revision surgery with extended stems with either constrained or limited condylar knee prosthesis.

Results: The duration of follow-up averaged 4.3 years. The Hospital for Special Surgery (HSS) knee score before fracture averaged 91 + 7.01 points (89-95 points) and 85.5 + 6.18 points (81-90 points) at the last follow-up. The average range of motion of knee joint before fracture was 115.7 [+7.6] (110 [~126]), and 101.3 [+9.8] (85 [~115]) at the last follow-up. There was no significant statistical difference. No complications such as infection, component loosening or nonunion. 2 patients had lower extremity vein thrombosis.

Conclusion: Revision surgery of the knee for the periprosthetic fractures with proper prosthetic selection can attain good outcomes after primary total knee arthroplasty. Reasonable and correct procedure is the main principle for a successful operation. The benefits and applicability of revision TKA is the reconstructive solution for the issues of prosthetic knee fractures, is highly recommended.