Lewis Daniel P, Tarrant Seth M, MacKenzie Stuart, Cornford Lachlan, Sato Toru, Shiota Naofumi, Balogh Zsolt J
John Hunter Hospital, Newcastle, NSW, Australia.
University of Newcastle, Newcastle, NSW, Australia; and.
OTA Int. 2023 Mar 28;6(1 Suppl):e241. doi: 10.1097/OI9.0000000000000241. eCollection 2023 Mar.
Knee arthroplasty, both total knee and unicompartmental, has had a significant impact on millions of patients globally. Although satisfaction is usually high, complications such as periprosthetic fracture are increasingly common. Distal femur periprosthetic fractures are relatively well researched and understood in comparison with periprosthetic proximal tibia fractures (PTFs). The management of PTFs is essentially an evidence-free area. This review explores the literature (or lack thereof) and integrates cases from Australia and Japan. As it stands, there is scant literature relating to all facets of PTFs, including, most concerningly, the management of them. Larger studies are required to help further investigate this important interface between arthroplasty and orthopaedic trauma. As a guide, those with loose prostheses will likely benefit most from revision total knee arthroplasty, while those with well-fixed prostheses can be managad according to the fracture with homage paid to the presence of the prosthesis. The use of periarticular locked plates is likely a better option over conventional large or small fragment plates. Nonoperative management is a viable option for selected individuals and can be associated with favorable outcomes.
膝关节置换术，包括全膝关节置换术和单髁置换术，已对全球数百万患者产生了重大影响。尽管患者满意度通常较高，但诸如假体周围骨折等并发症却日益常见。与假体周围胫骨近端骨折（PTF）相比，股骨远端假体周围骨折的研究和了解相对较多。PTF的治疗基本上是一个缺乏循证依据的领域。本综述探讨了相关文献（或缺乏相关文献的情况），并纳入了来自澳大利亚和日本的病例。目前，关于PTF各个方面的文献很少，最令人担忧的是，包括其治疗方法。需要开展更大规模的研究，以进一步深入探究关节置换术与骨科创伤这一重要交叉领域。作为指导原则，假体松动的患者可能从翻修全膝关节置换术中获益最大，而假体固定良好的患者可根据骨折情况进行处理，同时要考虑到假体的存在。与传统的大或小骨折块钢板相比，使用关节周围锁定钢板可能是更好的选择。非手术治疗对于部分特定患者是一种可行的选择，且可能会带来良好的治疗效果。
