Singh Somesh P, Bhalodiya Haresh P
Department of Orthopaedics, Civil Hospital and B. J. Medical College, Ahmedabad, India.
Indian J Orthop. 2013 Nov;47(6):591-7. doi: 10.4103/0019-5413.121586.
Periprosthetic supracondylar femoral fractures following total knee arthroplasty (TKA) are infrequent, but is a devastating complication. The purpose of this study was to evaluate the incidence and outcomes of periprosthetic supracondylar femoral fractures following TKA using nonoperative as well as open reduction and internal fixation (ORIF) techniques.
Between January 2004 and December 2010, we followed 3,920 operated patients of total knee arthroplasty (TKA) and identified 23 patients with periprosthetic supracondylar fractures. A retrospective analysis of the records of these patients was conducted. Details regarding pre fracture status, treatment offered and the present status were also recorded and analyzed. Time from index arthroplasty to periprosthetic fracture ranged from five days to six years. There were 17 women and 6 men and the average age was 68.26 years (range 52-83 years). Of the 23 patients, 20 patients were treated by operative method, whereas only three patients with relatively undisplaced fractures were treated nonoperatively.
The total incidence of periprosthetic fractures in operated cases of TKA was 0.58%. Three patients had infection after surgery. As per radiological assessment, two of three conservatively treated cases had malunion, whereas among 20 cases treated operatively, 16 had primary union with one malunion. Two patients had union after bone grafting, whereas two had nonunion. The average reduction in the knee score after fracture was 20.53%. Twenty one patients were able to achieve limited but independent activity.
Desirable results for periprosthetic fractures can be obtained if proper and timely intervention is done, taking into account the other comorbid conditions. However, short duration of followup and small number of patients were major limiting factors in this study.
全膝关节置换术（TKA）后股骨髁上假体周围骨折并不常见，但却是一种灾难性并发症。本研究的目的是评估采用非手术以及切开复位内固定（ORIF）技术治疗TKA后股骨髁上假体周围骨折的发生率及治疗结果。
2004年1月至2010年12月期间，我们对3920例行全膝关节置换术（TKA）的患者进行随访，确定了23例假体周围髁上骨折患者。对这些患者的记录进行回顾性分析。还记录并分析了骨折前状态、所采用的治疗方法及目前状况的详细信息。从初次置换术至假体周围骨折的时间为5天至6年。其中女性17例，男性6例，平均年龄68.26岁（范围52 - 83岁）。23例患者中，20例采用手术方法治疗，而仅有3例骨折相对无移位的患者采用非手术治疗。
TKA手术病例中假体周围骨折的总发生率为0.58%。3例患者术后发生感染。根据影像学评估，3例保守治疗病例中有2例出现骨不连，而20例手术治疗病例中，16例一期愈合，1例骨不连。2例患者植骨后愈合，2例未愈合。骨折后膝关节评分平均下降20.53%。21例患者能够实现有限但独立的活动。
如果考虑到其他合并症并进行适当及时的干预，假体周围骨折可获得理想的治疗结果。然而，本研究的主要限制因素是随访时间短和患者数量少。
