Smith Tyler J, Siddiqi Ahmed, Forte Salvador A, Judice Anthony, Sculco Peter K, Vigdorchik Jonathan M, Schwarzkopf Ran, Springer Bryan D
Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
Department of Orthopedics, Cleveland Clinic Foundation, Cleveland, Ohio.
JBJS Rev. 2021 Jan 26;9(1):e20.00091. doi: 10.2106/JBJS.RVW.20.00091.
Use of computer-assisted navigation (CAN) and robotic-assisted (RA) surgery in total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) both necessitate the use of tracking pins rigidly fixed to the femur and tibia. Although periprosthetic fractures through tracking pin sites are rare, there is a paucity of literature on this potential complication. Therefore, the purpose of this study was to perform a systematic review of the current literature to assess the incidence and clinical outcomes of periprosthetic fractures through tracking pin sites following CAN and RA TKA and UKA.
A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using the PubMed, MEDLINE, and Cochrane databases in April 2020. Studies were assessed for the presence of pin site fractures, fracture characteristics, and clinical outcomes.
Seventeen clinical studies (5 case series, 1 cohort study, and 11 case reports) involving 29 pin-related fractures were included for review. The overall incidence ranged from 0.06% to 4.8%. The mean time from index arthroplasty to fracture was 9.5 weeks (range, 0 to 40 weeks). The majority of fractures occurred in the femoral diaphysis (59%). Nineteen fractures (66%) were displaced and 10 (34%) were nondisplaced or occult. The majority of cases were atraumatic in nature or involved minor trauma and were typically preceded by persistent leg pain. A transcortical pin trajectory, large pin diameter (>4 mm), diaphyseal fixation, multiple placement attempts, and the use of non-self-drilling, non-self-tapping pins were the most commonly reported risk factors for pin-related periprosthetic fractures following CAN or RA TKA.
Surgeons should maintain a high index of suspicion for pin-related fractures in patients with ongoing leg or thigh pain after CAN or RA TKA in order to avoid fracture displacement and additional morbidity. As CAN and RA TKA have unique complication risks, the debate regarding the value of technology-assisted TKA and its cost-effectiveness continues.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
在全膝关节置换术（TKA）和单髁膝关节置换术（UKA）中使用计算机辅助导航（CAN）和机器人辅助（RA）手术都需要使用刚性固定在股骨和胫骨上的跟踪针。虽然通过跟踪针部位发生的假体周围骨折很少见，但关于这种潜在并发症的文献却很匮乏。因此，本研究的目的是对当前文献进行系统综述，以评估CAN和RA TKA及UKA术后通过跟踪针部位发生的假体周围骨折的发生率和临床结果。
2020年4月，按照PRISMA（系统评价和Meta分析的首选报告项目）指南，使用PubMed、MEDLINE和Cochrane数据库进行了系统综述。评估研究中是否存在针道骨折、骨折特征和临床结果。
纳入17项临床研究（5个病例系列、1项队列研究和11篇病例报告），共涉及29例与针相关的骨折进行综述。总体发生率为0.06%至4.8%。从初次关节置换到骨折的平均时间为9.5周（范围为0至40周）。大多数骨折发生在股骨干（59%）。19例骨折（66%）发生移位，10例（34%）未移位或隐匿性骨折。大多数病例本质上是无创伤性的或涉及轻微创伤，通常之前有持续的腿痛。皮质穿针轨迹、大针直径（>4mm）、骨干固定、多次置入尝试以及使用非自钻、非自攻针是CAN或RA TKA术后与针相关的假体周围骨折最常报道的危险因素。
对于CAN或RA TKA术后持续腿痛或大腿痛的患者，外科医生应高度怀疑与针相关的骨折，以避免骨折移位和额外的发病率。由于CAN和RA TKA有独特的并发症风险，关于技术辅助TKA的价值及其成本效益的争论仍在继续。
治疗性四级。有关证据水平的完整描述，请参阅作者指南。
