Fixation of a Felix IV Periprosthetic Tibia Fracture Using Synthetic Ligaments: A Case Report

Fixation of the Felix IV tibial fractures after total knee arthroplasty is complicated. Additionally, the rarity of this type of injury further complicates the situation due to the lack of established fixation techniques, in contrast to other periprosthetic knee fractures. Artificial ligaments are currently used in a wide range of orthopedic procedures, from anterior cruciate ligament reconstruction to tendon and ligament augmentation in different joints. Using artificial ligaments for these specific types of fractures may offer an advantage. A lady in her late 70s presented with a Felix IV fracture, ongoing knee pain, and distal wound dehiscence following a twisting knee injury on postoperative day 14 after her complex primary total knee replacement, where a rotating hinge implant was used. In this particular case, fixation with plates and screws was not possible due to poor bone quality and the nature of the implant. Therefore, fixation was performed using Ortho-tape, a polyethylene terephthalate (polyester) (Neoligaments, Leeds, United Kingdom), along with FiberWire (Ethicon, Raritan, New Jersey, United States) to manage her injury. The aim of this report is to introduce a novel surgical technique employing artificial ligaments, specifically Ortho-tape, a polyethylene terephthalate (polyester) material (Neoligaments), and FiberWire (Ethicon), without the use of metal components. Positive clinical and radiographic outcomes at the 18-month follow-up demonstrate that this method is effective in restoring knee joint extension, minimizing disabilities, and alleviating pain associated with periprosthetic Felix IV fractures.