Managing periprosthetic tibia fractures: International perspectives.

Area of Science:

• Orthopaedic Surgery
• Biomedical Engineering
• Trauma Surgery

Background:

• Knee arthroplasty significantly improves patient quality of life, but complications like periprosthetic fractures are rising.
• Periprosthetic proximal tibia fractures (PTFs) are less understood than distal femur fractures, presenting a significant clinical challenge.
• Current management strategies for PTFs lack robust evidence, necessitating further research.

Purpose of the Study:

• To review the existing literature on periprosthetic proximal tibia fractures (PTFs).
• To explore current management approaches and identify evidence gaps for PTFs.
• To provide guidance on managing PTFs based on prosthesis fixation and fracture characteristics.

Main Methods:

• Comprehensive literature search on periprosthetic proximal tibia fractures (PTFs).
• Integration of clinical cases from Australia and Japan to illustrate management scenarios.
• Analysis of fracture characteristics, prosthesis status, and treatment outcomes.

Main Results:

• A significant lack of published research exists regarding the management of PTFs.
• Revision total knee arthroplasty is recommended for PTFs with loose prostheses.
• Periarticular locked plates may offer superior outcomes compared to conventional plates for well-fixed PTFs.

Conclusions:

• The management of periprosthetic proximal tibia fractures (PTFs) remains an evidence-free domain requiring urgent investigation.
• Treatment decisions for PTFs should consider prosthesis fixation, with revision arthroplasty for loose components.
• Nonoperative management can be a viable option for select PTF cases, potentially yielding favorable outcomes.