Undersizing of the tibial component in Oxford unicompartmental knee arthroplasty (UKA) increases the risk of periprosthetic fractures.
Knee arthroplasty
Medial
Periprosthetic fracture
UKA
Undersizing
Unicompartmental
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
12 Jan 2024
12 Jan 2024
Historique:
received:
30
03
2023
accepted:
11
11
2023
medline:
12
1
2024
pubmed:
12
1
2024
entrez:
12
1
2024
Statut:
aheadofprint
Résumé
Tibial periprosthetic fractures (TPF) after unicompartmental knee arthroplasty (UKA) are a rare condition that affects about 1% of cases. Known risk factors include age, sex, body mass index (BMI), and bone density, as well as surgical technique and prosthesis design. The purpose of the study was to determine if undersizing of the tibial component in relation to the femoral component increases the risk of tibial periprosthetic fractures. Over a 6-year-period 1542 patients with cemented (n = 363) and uncemented (n = 1179) medial UKA were retrospectively evaluated. Tibial periprosthetic fractures were identified and classified, and epidemiologic data were documented at follow-up. Undersizing was defined as a smaller tibial component compared to the femoral implant. The association of potential risk factors for TPF with the incidence of TPF was investigated with binominal logistic regression. Fourteen patients (0.9%) suffered from TPF at a median of 1 month after surgery. The mean follow-up period was 5.9 ± 1.7 years. Fractures were more common in cases with undersized tibial components [odds ratio (OR) 3.2, p < 0.05]. Furthermore, older age (OR 1.1, p < 0.05) and female sex (OR 6.5, p < 0.05) were identified as significant risk factors, while BMI (p = 0.8) and cemented implantation (p = 0.2) had no effect on fracture rate. Revision surgery included open reduction and internal fixation or conversion to total knee arthroplasty. Undersizing of implant sizes in UKA increases the risk for TPF especially in patients with small tibial implants. Therefore, mismatched implants should be avoided for UKA particularly when risk factors like obesity, older age, or female gender are present. Tibial periprosthetic fractures were successfully treated by open reduction and internal fixation or conversion to total knee arthroplasty.
Identifiants
pubmed: 38214714
doi: 10.1007/s00402-023-05142-z
pii: 10.1007/s00402-023-05142-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
(2019) New Zealand arthroplasty registry (2019) NZJR 20 year report. https://www.nzoa.org.nz/nzoa-joint-registry . Accessed 10 Sept 2022
Arirachakaran A, Choowit P, Putananon C, Muangsiri S, Kongtharvonskul J (2015) Is unicompartmental knee arthroplasty (UKA) superior to total knee arthroplasty (TKA)? A systematic review and meta-analysis of randomized controlled trial. Eur J Orthop Surg Traumatol 25:799–806
doi: 10.1007/s00590-015-1610-9
pubmed: 25676725
Bonnick SL (2006) Osteoporosis in men and women. Clin Cornerstone 8:28–39
doi: 10.1016/S1098-3597(06)80063-3
pubmed: 17591574
Brown NM, Engh G, Fricka K (2019) Periprosthetic fracture following partial knee arthroplasty. J Knee Surg 32:947–952
doi: 10.1055/s-0038-1672204
pubmed: 30282098
Burger JA, Jager T, Dooley MS, Zuiderbaan HA, Kerkhoffs G, Pearle AD (2022) Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 30:852–874
doi: 10.1007/s00167-021-06449-3
pubmed: 33528591
Cimen K, Otag I, Oztemur Z (2023) The relationship of distal femur and proximal tibia morphology with anterior cruciate ligament injuries. Surg Radiol Anat 45:495–501
doi: 10.1007/s00276-023-03097-9
pubmed: 36752835
Clarius M, Aldinger PR, Bruckner T, Seeger JB (2009) Saw cuts in unicompartmental knee arthroplasty: an analysis of sawbone preparations. Knee 16:314–316
doi: 10.1016/j.knee.2008.12.018
pubmed: 19196514
Clarius M, Haas D, Aldinger PR, Jaeger S, Jakubowitz E, Seeger JB (2010) Periprosthetic tibial fractures in unicompartmental knee arthroplasty as a function of extended sagittal saw cuts: an experimental study. Knee 17:57–60
doi: 10.1016/j.knee.2009.05.004
pubmed: 19539478
Crawford DA, Berend KR, Lombardi AV (2018) Management of the failed medial unicompartmental knee arthroplasty. J Am Acad Orthop Surg 26:e426–e433
doi: 10.5435/JAAOS-D-17-00107
pubmed: 30113345
Della Rocca GJ, Leung KS, Pape HC (2011) Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma 25:S66–S70
doi: 10.1097/BOT.0b013e31821b8c28
pubmed: 21566478
Fitch AA, Terhune EB, Cohn MR, Wright-Chisem J, Weatherford BM, Williams JC (2022) Periprosthetic tibial plateau fractures after unicompartmental knee arthroplasty are successfully treated with open reduction and internal fixation. Orthopedics. https://doi.org/10.3928/01477447-20220425-041-6
doi: 10.3928/01477447-20220425-041-6
pubmed: 35485885
Gupta V, Kejriwal R, Frampton C (2020) Revision following cemented and uncemented Oxford-III primary medial unicompartmental knee replacements: a 19-year analysis from the New Zealand joint registry. JBJS 102:1777–1783
doi: 10.2106/JBJS.19.01443
Hamilton T, Pandit H, Lombardi A, Adams J, Oosthuizen C, Clavé A et al (2016) Radiological decision aid to determine suitability for medial unicompartmental knee arthroplasty: development and preliminary validation. Bone Joint J 98:3–10
doi: 10.1302/0301-620X.98B10.BJJ-2016-0432.R1
pubmed: 27694509
Hiranaka T, Yoshikawa R, Yoshida K, Michishita K, Nishimura T, Nitta S et al (2020) Tibial shape and size predicts the risk of tibial plateau fracture after cementless unicompartmental knee arthroplasty in Japanese patients. Bone Joint J 102-B:861–867
doi: 10.1302/0301-620X.102B7.BJJ-2019-1754.R1
pubmed: 32600131
Houskamp DJ, Tompane T, Barlow BT (2020) What is the critical tibial resection depth during unicompartmental knee arthroplasty? A biomechanical study of fracture risk. J Arthroplasty 35:2244–2248
doi: 10.1016/j.arth.2020.04.005
pubmed: 32362480
Inoue S, Akagi M, Asada S, Mori S, Zaima H, Hashida M (2016) The valgus inclination of the tibial component increases the risk of medial tibial condylar fractures in unicompartmental knee arthroplasty. J Arthroplasty 31:2025–2030
doi: 10.1016/j.arth.2016.02.043
pubmed: 27038862
Kamenaga T, Hiranaka T, Nakano N, Hayashi S, Fujishiro T, Okamoto K et al (2022) Short distance from the keel to the posterior tibial cortex is associated with fracture after cementless Oxford UKA in Asian patients. Knee Surg Sports Traumatol Arthrosc 30:1220–1230
doi: 10.1007/s00167-021-06553-4
pubmed: 33825909
Kendrick B, Kaptein B, Valstar E, Gill H, Jackson W, Dodd C et al (2015) Cemented versus cementless Oxford unicompartmental knee arthroplasty using radiostereometric analysis: a randomised controlled trial. Bone Joint J 97:185–191
doi: 10.1302/0301-620X.97B2.34331
pubmed: 25628280
Keppler L, Klingbeil S, Keppler AM, Becker J, Fulghum C, Michel B et al (2022) Impact of keel saw blade design and thickness on the incidence of tibial plateau fracture and tibial implant-loosening in cementless medial UKR. BMC Musculoskelet Disord 23:1–8
doi: 10.1186/s12891-022-05500-9
Kerens B, Schotanus M, Boonen B, Boog P, Emans P, Lacroix H et al (2017) Cementless versus cemented Oxford unicompartmental knee arthroplasty: early results of a non-designer user group. Knee Surg Sports Traumatol Arthrosc 25:703–709
doi: 10.1007/s00167-016-4149-3
pubmed: 27161197
Li ZX, Tan AHC (2021) An early periprosthetic fracture of a cementless oxford unicompartmental knee arthroplasty: risk factors and mitigation strategies. J Orthop Case Rep 11:65–69
pubmed: 34327169
pmcid: 8310628
Liddle AD, Pandit H, O’Brien S, Doran E, Penny ID, Hooper GJ et al (2013) Cementless fixation in Oxford unicompartmental knee replacement a multicentre study of 1000 knees. Bone Joint J 95B:181–187
doi: 10.1302/0301-620X.95B2.30411
Mohammad HR, Matharu GS, Judge A, Murray DW (2020) Comparison of the 10-year outcomes of cemented and cementless unicompartmental knee replacements: data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Acta Orthop 91:76
doi: 10.1080/17453674.2019.1680924
pubmed: 31635503
Mohammad HR, Matharu GS, Judge A, Murray DW (2020) New surgical instrumentation reduces the revision rate of unicompartmental knee replacement: a propensity score matched comparison of 15,906 knees from the National Joint Registry. Knee 27:993–1002
doi: 10.1016/j.knee.2020.02.008
pubmed: 32115338
Nettrour JF, Ellis RT, Hansen BJ, Keeney JA (2020) High failure rates for unicompartmental knee arthroplasty in morbidly obese patients: a two-year minimum follow-up study. J Arthroplasty 35:989–996
doi: 10.1016/j.arth.2019.11.003
pubmed: 31796233
Niinimaki T, Eskelinen A, Makela K, Ohtonen P, Puhto AP, Remes V (2014) Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship: a 27-year finnish registry study. Clin Orthop Relat Res 472:1496–1501
doi: 10.1007/s11999-013-3347-2
pubmed: 24249531
Reich MS, Baer MR (2020) Is cementless superior? Commentary on an article by Vikesh Gupta, MBChB, et al.: Revision following cemented and uncemented Oxford-III primary medial unicompartmental knee replacements a 19-year analysis from the New Zealand joint registry. JBJS 102:e118
doi: 10.2106/JBJS.20.01473
Stavrakis A, Arshi A, Chiou D, Hsiue P, Horneff JG 3rd, Photopoulos C (2022) Cemented versus noncemented total knee arthroplasty outcomes. J Am Acad Orthop Surg 30:273–280
doi: 10.5435/JAAOS-D-21-00353
pubmed: 35167508
Thien TM, Chatziagorou G, Garellick G, Furnes O, Havelin LI, Mäkelä K et al (2014) Periprosthetic femoral fracture within two years after total hip replacement: analysis of 437,629 operations in the nordic arthroplasty register association database. JBJS 96:e167
doi: 10.2106/JBJS.M.00643
Wilson HA, Middleton R, Abram SGF, Smith S, Alvand A, Jackson WF et al (2019) Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 364(364):l352
doi: 10.1136/bmj.l352
pubmed: 30792179
pmcid: 6383371
Yoshikawa R, Hiranaka T, Okamoto K, Fujishiro T, Hida Y, Kamenaga T et al (2020) The medial eminence line for predicting tibial fracture risk after unicompartmental knee arthroplasty. Clin Orthop Surg 12:166–170
doi: 10.4055/cios19011
pubmed: 32489537
pmcid: 7237250