TY - JOUR
T1 - Undersizing of the tibial component in Oxford unicompartmental knee arthroplasty (UKA) increases the risk of periprosthetic fractures
AU - Watrinet, Julius
AU - Blum, Philipp
AU - Maier, Michael
AU - Klingbeil, Steffen
AU - Regenbogen, Stephan
AU - Augat, Peter
AU - Schipp, Rolf
AU - Reng, Wolfgang
N1 - Lehr-KH BGU Murnau;
Augat: Institute Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
PY - 2024/3
Y1 - 2024/3
N2 - INTRODUCTION: Tibial periprosthetic fractures (TPF) after unicompartmental knee arthroplasty (UKA) are a rare condition that affects about 1% of cases. Known risk factors include age, sex, body mass index (BMI), and bone density, as well as surgical technique and prosthesis design. The purpose of the study was to determine if undersizing of the tibial component in relation to the femoral component increases the risk of tibial periprosthetic fractures.MATERIAL AND METHODS: Over a 6-year-period 1542 patients with cemented (n = 363) and uncemented (n = 1179) medial UKA were retrospectively evaluated. Tibial periprosthetic fractures were identified and classified, and epidemiologic data were documented at follow-up. Undersizing was defined as a smaller tibial component compared to the femoral implant. The association of potential risk factors for TPF with the incidence of TPF was investigated with binominal logistic regression.RESULTS: Fourteen patients (0.9%) suffered from TPF at a median of 1 month after surgery. The mean follow-up period was 5.9 ± 1.7 years. Fractures were more common in cases with undersized tibial components [odds ratio (OR) 3.2, p < 0.05]. Furthermore, older age (OR 1.1, p < 0.05) and female sex (OR 6.5, p < 0.05) were identified as significant risk factors, while BMI (p = 0.8) and cemented implantation (p = 0.2) had no effect on fracture rate. Revision surgery included open reduction and internal fixation or conversion to total knee arthroplasty.CONCLUSIONS: Undersizing of implant sizes in UKA increases the risk for TPF especially in patients with small tibial implants. Therefore, mismatched implants should be avoided for UKA particularly when risk factors like obesity, older age, or female gender are present. Tibial periprosthetic fractures were successfully treated by open reduction and internal fixation or conversion to total knee arthroplasty.
AB - INTRODUCTION: Tibial periprosthetic fractures (TPF) after unicompartmental knee arthroplasty (UKA) are a rare condition that affects about 1% of cases. Known risk factors include age, sex, body mass index (BMI), and bone density, as well as surgical technique and prosthesis design. The purpose of the study was to determine if undersizing of the tibial component in relation to the femoral component increases the risk of tibial periprosthetic fractures.MATERIAL AND METHODS: Over a 6-year-period 1542 patients with cemented (n = 363) and uncemented (n = 1179) medial UKA were retrospectively evaluated. Tibial periprosthetic fractures were identified and classified, and epidemiologic data were documented at follow-up. Undersizing was defined as a smaller tibial component compared to the femoral implant. The association of potential risk factors for TPF with the incidence of TPF was investigated with binominal logistic regression.RESULTS: Fourteen patients (0.9%) suffered from TPF at a median of 1 month after surgery. The mean follow-up period was 5.9 ± 1.7 years. Fractures were more common in cases with undersized tibial components [odds ratio (OR) 3.2, p < 0.05]. Furthermore, older age (OR 1.1, p < 0.05) and female sex (OR 6.5, p < 0.05) were identified as significant risk factors, while BMI (p = 0.8) and cemented implantation (p = 0.2) had no effect on fracture rate. Revision surgery included open reduction and internal fixation or conversion to total knee arthroplasty.CONCLUSIONS: Undersizing of implant sizes in UKA increases the risk for TPF especially in patients with small tibial implants. Therefore, mismatched implants should be avoided for UKA particularly when risk factors like obesity, older age, or female gender are present. Tibial periprosthetic fractures were successfully treated by open reduction and internal fixation or conversion to total knee arthroplasty.
KW - Arthroplasty, Replacement, Knee/adverse effects
KW - Female
KW - Humans
KW - Knee Joint/surgery
KW - Knee Prosthesis/adverse effects
KW - Osteoarthritis, Knee/surgery
KW - Periprosthetic Fractures/epidemiology
KW - Retrospective Studies
KW - Tibia/surgery
KW - Tibial Fractures/etiology
KW - Treatment Outcome
U2 - 10.1007/s00402-023-05142-z
DO - 10.1007/s00402-023-05142-z
M3 - Original Article
C2 - 38214714
SN - 0936-8051
VL - 144
SP - 1353
EP - 1359
JO - ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
JF - ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
IS - 3
ER -