Periprosthetic Femoral Fractures in Total Knee Arthroplasty

Abstract

Total joint arthroplasty has greatly improved the treatment of knee arthrosis, but still is not without complications. Supracondylar fractures above total knee replacements are an uncom‐ mon complication (incidence 0,3% to 2.5%), occuring more frequently in patients older than 60 years with osteoporotic bone. The rate of these fractures is expected to increase in the future because of the growing number of total knee replacements and greater level of acitivity among elderly patients. The timing of such fractures has been reported to range from early in the postoperative period to more than a decade after surgery, with a mean of 2 to 4 years. During the past two decades authors were not agreed in the definition of periprosthetic supracondylar region: the lower 3 inches (7cm) of the femur [1]; 9 cm proximal to the knee joint line [2]; all fractures within 15 cm proximal to the knee joint line [3]. Generally, based on the older literature, supracondylar periprosthetic fractures were those within 15 cm of the joint line, or in the case of stemmed component, within 5 cm of the proximal end of the implant. Never‐ theless, the most important is understanding that these fractures occur in regions of stress concentration adjacent to a prosthetic component, and that the presence of the prosthesis has a significant effect on fracture treatment. So, we suggest that fractures above total knee replacement should be considered supracondylar fractures if they extend within 7 cm of the prosthetic joint line or if they are within 2 cm of the femoral prosthetic flange.