Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
Orthop Traumatol Surg Res. 2020 May;106(3):449-458. doi: 10.1016/j.otsr.2020.01.008. Epub 2020 Mar 14.
Periprosthetic tibial fracture after total knee arthroplasty (TKA) is rare, but jeopardizes implant survival. The main objective of the present study was to assess treatment efficacy, on the hypothesis that surgery provides good long-term results.
A two-center retrospective study included 15 patients (6 male, 9 female: mean age, 71.8±10.2 years), managed between 1997 and 2017 for isolated tibial fracture after TKA. Patients were assessed clinically (IKS, inverted Oxford, Parker and SF-12 scores) and radiologically. Complications and revision surgeries were collated. Fractures were classified on the SoFCOT classification: 9 stable implants (4 type B1, 5 type C1), 4 periprosthetic osteolyses (1 type A3, 2 type B3, 1 type C3), and 2 loosenings (type A2). Treatments comprised: non-operative treatment (1 bed-ridden patient), 11 osteosyntheses for fracture on stable implant (2 standard plates, 7 locking plates, 2 intramedullary nailings), and 3 implant replacements by cemented long stem models for loosening.
Mean follow-up was 28 months (range, 12-120 months). Consolidation was achieved in 13 cases, at a mean 15 weeks. Complications comprised: 4 infections, 2 cases of secondary displacement, and 2 of non-union. Surgical revision was required in 8 cases, including 2 secondary implant revision procedures. Functional results were good in 10 cases. At last follow-up, mean Parker score was 7 (range, 4-8.5), Oxford score 32 (range, 16-39), and IKS score 150 (range, 85-167) with knee and function scores respectively 78 (range, 55-86) and 75 (range, 30-85).
Radiologic and clinical results were encouraging, but with impaired quality of life and a high rate of complications.
IV, retrospective cohort study.
全膝关节置换术后（TKA）发生的胫骨假体周围骨折较为罕见，但会危及假体的生存。本研究的主要目的是评估治疗效果，假设手术可提供良好的长期结果。
这是一项来自两个中心的回顾性研究，共纳入 15 名患者（6 名男性，9 名女性；平均年龄 71.8±10.2 岁），这些患者于 1997 年至 2017 年间因 TKA 后发生胫骨骨折而接受治疗。患者的临床（IKS、倒置牛津、帕克和 SF-12 评分）和影像学表现得到了评估。同时收集了并发症和翻修手术的相关信息。骨折按照 SoFCOT 分类进行分类：9 例稳定的假体（4 型 B1，5 型 C1），4 例假体周围骨溶解（1 型 A3，2 型 B3，1 型 C3）和 2 例松动（2 型 A2）。治疗方法包括：非手术治疗（1 例卧床患者）、11 例稳定假体骨折的内固定治疗（2 例标准钢板，7 例锁定钢板，2 例髓内钉）和 3 例松动假体的翻修（骨水泥长柄模型）。
平均随访时间为 28 个月（12-120 个月）。13 例患者获得了骨折愈合，平均时间为 15 周。并发症包括：4 例感染，2 例发生二次移位，2 例发生骨折不愈合。8 例患者需要进行手术翻修，包括 2 例二次假体翻修手术。10 例患者的功能结果良好。末次随访时，平均帕克评分 7 分（4-8.5 分），牛津评分 32 分（16-39 分），IKs 评分 150 分（85-167 分），膝关节和功能评分分别为 78 分（55-86 分）和 75 分（30-85 分）。
影像学和临床结果令人鼓舞，但生活质量受损，并发症发生率较高。
IV 级，回顾性队列研究。
