Abstract
We report an 85-year-old woman with dementia and dependent for normal life activities who was admitted due to a left periprosthetic tibial fracture. The tibial component was replaced by one with a long stem and she was discharged. Four weeks after the intervention the patient was re-admitted due to an acute prosthetic joint infection. All the components were removed and a bone-cement spacer with a handmade stem with a metal core was implanted. Radiological signs of fracture consolidation were observed after 3 months of follow-up. Due to the previous health status of the patient, it was decided to keep the spacer as a definitive treatment. After 24 months, the patient was able to sit without pain and to stand up with help using a knee brace. There were no radiological or clinical signs of infection.
Highlights
In contrast to fractures of the distal femur or patella associated with a total knee arthroplasty (TKA), periprosthetic fractures of the tibia are very uncommon [1]
Fractures associated with a wellfixed prosthesis could be successfully treated with the usual principles of fracture management, while those associated with loosening of the components require a revision arthroplasty
We present a case managed with an antibioticloaded bone cement spacer with handmade stem and a metal core
Summary
In contrast to fractures of the distal femur or patella associated with a total knee arthroplasty (TKA), periprosthetic fractures of the tibia are very uncommon [1]. The largest series reported by Felix et al, [2] classified these fractures according to the anatomical location of the fracture and prosthesis fixation. Infection after treatment of this type of fracture has no frequently been described. An 85-year-old woman with hypertension, dementia and dependent for normal life activities presented after an accidental fall with a left periprosthetic tibial fracture around total knee arthroplasty (Alpina®, Biomet-France) implanted 9 years ago (Fig. 1). The fracture was classified as type IIB according to the Felix classification [2] (adjacent to the stem and with an unstable tibial component). The intraoperative cultures were positive for extended-spectrum beta-lactamase (ESBL) producing Escherichia coli and ampicillin- and high
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