Periprosthetic Fractures After Total Knee Arthroplasty-A Two-Center Study and Systematic Review of the Literature

Background and Objectives: Periprosthetic fracture is a complex and urgent condition in orthopedic surgery. It requires an individual approach to every patient, and treatment is associated with high risk of complications. Materials and methods: Fifty-six patients treated due to periprosthetic fracture (PPF) after total knee arthroplasty were retrospectively analyzed according to surgical protocol, treatment time, and complication rate. The results were compared to the available literature. Results: Almost all patients (91%) were treated surgically-revision total knee arthroplasty or osteosynthesis. A therapeutic success was achieved in 81% of all cases. Replacement of the femoral component with the semi-constrained type of implant was performed most frequently during revision total knee arthroplasty. In PPFs of the femur, destabilization of fixation was observed mainly in type II according to the Lewis-Rorabeck classification. Conclusions: Despite the complexity of the problem, treatment of periprosthetic knee fractures can be effective. Provided that the implant remains stable, osteosynthesis is a good treatment option for PPF of the femur. In revision total knee arthroplasty, implants with a higher level of restriction are usually used to ensure better knee joint stability.