Dugdale Evan M, Alter Thomas D, Stuart Michael J, Sems Stephen A, Yuan Brandon J, Spangehl Mark J, Springer Bryan D, Berry Daniel J, Abdel Matthew P
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Orthopedic Surgery, Mayo Clinic Arizona, Scottsdale, Arizona.
J Bone Joint Surg Am. 2025 May 23;107(14):1579-1589. doi: 10.2106/JBJS.24.01407.
Periprosthetic tibial fractures around a total knee replacement (TKR) remain challenging to manage, with little published information for guidance. The purpose of this study was to review the types, management techniques, and outcomes of periprosthetic tibial fractures in the largest series to date.
We identified 300 periprosthetic tibial fractures (285 patients) around a TKR (43% in primary TKRs and 57% in revision TKRs) sustained between 1996 and 2020. Fractures were classified according to Felix et al. as Type I (tibial plateau), Type II (adjacent to stem), Type III (distal to stem), or Type IV (tibial tubercle), with subtypes A (well-fixed component), B (loose component), and C (intraoperative fracture). Of the fractures in this study, 53% were Type I, 24% were Type II, 16% were Type III, and 8% were Type IV. A total of 46% of fractures occurred intraoperatively, and 54% of fractures occurred postoperatively (61% subtype A, 39% subtype B). The mean patient age at fracture was 67 years, and 64% of patients were female. The mean follow-up was 6 years.
The intraoperative fracture incidence was 1.40% in revision TKRs and 0.10% in primary TKRs. Among intraoperative fractures, the 2-year survivorship free from tibial component revision was highest in Type I (100%) and lowest in Type IV (67%) (p < 0.001). For postoperative fractures, the 2-year survivorship free from any reoperation was 29% and the 2-year survivorship free from tibial component revision was 51%. Type-I postoperative fractures had the lowest 2-year survivorship free from tibial component revision (10%), whereas Type-III fractures had the highest survivorship (88%) (p < 0.001).
Intraoperative periprosthetic fracture of the tibia was fourteenfold more likely in revision TKRs compared with primary TKRs. Among all intraoperative fractures, Type-I fractures were well-tolerated, with 100% survivorship free from tibial component revision at 2 years. Conversely, Type-I postoperative fractures had only 10% survivorship at 2 years.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
全膝关节置换术（TKR）周围的假体周围胫骨骨折的处理仍然具有挑战性，公开的指导信息很少。本研究的目的是回顾迄今为止最大系列的假体周围胫骨骨折的类型、处理技术和结果。
我们确定了1996年至2020年间发生的300例TKR周围的假体周围胫骨骨折（285例患者）（初次TKR中占43%，翻修TKR中占57%）。骨折根据Felix等人的分类为I型（胫骨平台）、II型（靠近柄部）、III型（柄部远端）或IV型（胫骨结节），亚型为A（组件固定良好）、B（组件松动）和C（术中骨折）。本研究中的骨折，53%为I型，24%为II型，16%为III型，8%为IV型。共有46%的骨折发生在术中，54%的骨折发生在术后（A亚型占61%，B亚型占39%）。骨折时患者的平均年龄为67岁，64%的患者为女性。平均随访时间为6年。
翻修TKR术中骨折发生率为1.40%，初次TKR术中骨折发生率为0.10%。在术中骨折中，I型骨折2年免于胫骨组件翻修的生存率最高（100%），IV型骨折最低（67%）（p<0.001）。对于术后骨折，2年免于任何再次手术的生存率为29%，2年免于胫骨组件翻修的生存率为51%。I型术后骨折2年免于胫骨组件翻修的生存率最低（10%），而III型骨折生存率最高（88%）（p<0.001）。
与初次TKR相比，翻修TKR术中假体周围胫骨骨折的可能性高14倍。在所有术中骨折中，I型骨折耐受性良好，2年时免于胫骨组件翻修的生存率为100%。相反，I型术后骨折2年时生存率仅为10%。
治疗性III级。有关证据水平的完整描述，请参阅作者须知。
