Epidemiology and Classification of Tibial Periprosthetic Fractures Following Total Knee Arthroplasty.

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Abstract

Conflict of interest statement: R.E.D. declares research support from Johnson & Johnson, Biocomposites, CyMedica Orthopedics, Depuy Synthes, Flexion Therapeutics, Microport Orthopedics, Orthofix, Patient-Centered Outcomes Research Institute (PCORI), Smith & Nephew, Stryker, Tissue Gene, and United Orthopedic Corporation; board member/committee appointments for the Baltimore City Medical Society. M.A.M. declares royalties from Medicus Works LLC, Stryker, Medicus Works LLC, Up-to Date, Wolters Kluwer Health - Lippincott Williams & Wilkins; consulting relationships with 3M, Exactech, Inc, Johnson & Johnson, Regeneron Pharmaceuticals, Next Science, Pacira, Smith & Nephew, Stryker; stock or stock options in CERAS Health, MirrorAR, Peerwell, and USMI; research support from Johnson & Johnson, Medtronic, National Institutes of Health (NIAMS & NICHD), Organogenesis, Orthofix, Inc, Patient-Centered Outcomes Research Institute (PCORI), Stryker; editorial/governing board for Journal of Arthroplasty and Journal of Knee Surgery; and board/committee appointments for the American Association of Hip and Knee Surgeons, Hip Society, and Knee Society. 12. J Arthroplasty. 2024 Oct;39(10):2615-2620. doi: 10.1016/j.arth.2024.05.033. Epub 2024 May 15. Risk and Epidemiology of Periprosthetic Knee Fractures After Primary Total Knee Arthroplasty: A Nationwide Cohort Study. Risager SK(1), Arndt KB(2), Abrahamsen C(2), Viberg B(1), Odgaard A(3), Lindberg-Larsen M(1). Author information: (1)Department of Orthopaedic and traumatology, Odense University Hospital, Odense Denmark. (2)Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding Denmark. (3)Department of Orthopaedic Surgery and Traumatology, Rigshospitalet, Copenhagen Denmark. BACKGROUND: Periprosthetic knee fractures (PPKFs) following total knee arthroplasty (TKA) are uncommon, but potentially serious injuries. We analyze the risk and risk factors for a PPKF in standard primary TKA patients who have osteoarthritis and a minimally (cruciate-retaining TKAs without a femoral box cut) or posterior-stabilized TKA. In addition, we report the risk for patients who have other underlying knee disorders and/or a higher level of TKA constraint. METHODS: All primary TKAs were identified from the Danish National Patient Register and the Danish Knee Arthroplasty Register using data between 1997 and 2022. Subsequent fractures were identified through the International Classification of Diseases diagnosis code, Nordic Medico-Statistical Committee procedure code, or indication for revision TKA. RESULTS: We included 120,642 standard primary TKA patients who had 1,659 PPKFs. The cumulated proportions were 0.4% (95% confidence interval (CI) 0.3 to 0.4) at 2 years 0.8% (0.7 to 0.8) at 5 years. At 10 years, the cumulated proportion was 1.7% (1.6 to 1.8), with 1.3% in the femur, 0.2% in the patella, and 0.2% in the tibia. Significant risk factors were (hazard ratio [HR] [95% CI]); ipsilateral hip arthroplasty (2.3 [2.0 to 2.6]); women (2.1 [1.8 to 2.4]), osteoporosis (1.4 [1.2 to 1.7]); age 80+ (1.4 [1.3 to 1.6]), uncemented TKA (1.3 (1.1 to 1.5) and Charlson Comorbidity Index score 3+ (1.4 [1.1 to 1.8]). An additional 22,624 primary TKA patients who had other underlying knee disorders and/or a higher level of implant constraint were included with 633 PPKFs. The 10-year cumulated proportions were 8.3% (95% CI 6.9 to 9.8) when the underlying disorder was a previous fracture, 2.8% (2.2 to 3.5) for rheumatic disorders, and 5.2% (2.6 to 10.6) for osteonecrosis. In patients who had condylar constrained knees, it was 6.9% (5.1 to 9.4), and 12.4% (8.0 to 16.04) for hinges. CONCLUSIONS: In standard primary TKA patients, the 10-year cumulated proportion of PPKFs was 1.7%, and ipsilateral hip arthroplasty, women, osteoporosis, advanced age, uncemented TKA and higher Charlson Comorbidity Index increased the risk. Higher risks were observed in non-osteoarthritis patients and/or patients who had a higher level of TKA constraint. Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.arth.2024.05.033