Periprosthetic fractures about the knee - an overview

Several factors are conspiring to cause a dramatic increase in the incidence of periprosthetic fractures. First, the incidence of arthroplasty is increasing as the population ages. Second, arthroplasty is being performed in younger, more active patients, who live longer after their arthroplasty and are more likely to have subsequent trauma to their previously operated limb. Third, following lower extremity surgery, disuse osteopenia of the limb often occurs, increasing the risk of subsequent fracture in that same limb. This increased risk of later fracture is further aggravated by the implant placed at the previous surgery, which often functions as a mechanical stress riser. Careful attention to detail during knee arthroplasty or during fracture repair in which fixation is placed close to the knee is beneficial for minimizing the risk of subsequent periprosthetic fracture. Intraoperative vigilance, judicious use of force when inserting implants, and meticulous technical execution of the procedure may all reduce fracture complications postoperatively. This article reviews the prevalence of periprosthetic fractures about knee arthroplasties and fracture fixation constructs, and also provides a description of common recommendations intended to reduce the risk of periprosthetic fracture.