Periprosthetic Fractures Around Total Knee Arthroplasty

This chapter will discuss periprosthetic fractures adjacent to total knee arthroplasty (TKA). Fractures will be subdivided by anatomic location and timing of the injury. Intraoperative fractures are less common and often technique related, although there are certain patient and procedural risk factors. If recognized, they can often be stabilized with minimal effort and disruption to postoperative rehabilitation, but they may require intraoperative conversion to revision or stemmed implants, along with adjuvant fixation. Early postoperative fractures are likely the result of an unrecognized intraoperative fracture and are also likely technique related. Postoperative fractures can also occur late as a result of trauma or low energy falls and are often unrelated to the index TKA. Host risk factors such as osteoporosis, inflammatory disease, medication side effects and multiple falls also contribute to and complicate treatment of these injuries. Treatment of these injuries depends on anatomic location, stability of existing implants, bone quality, and host co-morbidities and activity level. Surgical treatment goals are immediate resolution of weight-bearing without restrictions, avoiding soft tissue and medical complications, and concurrently addressing underlying etiologies for fracture.