Case reportTibial plateau stress fracture: A complication of unicompartmental knee arthroplasty using 4 guide pinholes1
Section snippets
Case reports
All cases were in patients with a diagnosis of medial unicompartmental osteoarthritis treated with a cemented medial UKA. In each case, the tibial cutting jig was initially fixed with 2 pins and subsequently repositioned distally, creating 4 holes in the proximal tibia perpendicular to the long axis of the bone. The knee system used does have additional holes in the alignment jig to allow for repositioning without new pins. Despite this capability, the treating surgeon believed that additional
Discussion
Periprosthetic tibial fractures after TKA have been associated with improper component position, varus malalignment, and component loosening 1, 3. Rand and Coventry [3] reported on 15 stress fractures of the tibia after TKA that occurred at a mean time of 45 months after initial TKA. All required revision TKA. Felix, Stuart, and Hansen [1] reported 50 tibial plateau fractures after TKA that were associated with varus malalignment and loosening of the tibial component. Most of these required
Conclusion
We recommend avoiding multiple guide pin holes in the proximal tibia for UKA. This can be achieved by using one centrally placed pin in association with another form of stabilization such as a clamp at the ankle. Furthermore, a tibial cutting jig that can be adjusted to take a thicker cut using the same guide pins should be used. If 3 or more pin holes are deemed necessary for UKA, surgeons must be aware of the potential for tibial stress fracture and monitor patients accordingly. In addition,
References (9)
- et al.
Blood supply to the patellasignificance in total knee arthroplasty
J Arthroplasty
(1989) - et al.
Periprosthetic fractures of the tibia associated with total knee arthroplasty
Clin Orthop
(1997) - et al.
Stress fracture of the tibia after total knee arthroplasty
Arch Orthop Trauma Surg
(1997) - et al.
Stress fractures after total knee arthroplasty
J Bone Joint Surg Am
(1980)
Cited by (64)
Proximal tibial bone loss in the first 2 years after unicondylar knee arthroplasty: Anatomical pattern, predictors and clinical correlation
2021, KneeCitation Excerpt :Unicondylar knee arthroplasty (UKA) has gained popularity with satisfactory clinical results. Yet the success of the surgery is restricted by some complications specific to this surgery, such as medial tibial stress fracture [1,2], anteromedial tibial bone pain [3] and early tibial subsidence and loosening [4]. These complications have invited research on the underlying contributing factors such as increase in strain of proximal tibia after surgery [5,6], difference in strain pattern with different bone cuts and implant designs [7].
Anterior cruciate ligament avulsion fracture following medial unicompartmental knee arthroplasty: A case report
2021, Annals of Medicine and SurgeryMinimising tibial fracture after unicompartmental knee replacement: A probabilistic finite element study
2020, Clinical BiomechanicsDelayed tibial-platform periprosthetic stress fracture after unicompartmental knee arthroplasty: Uncommon and devastating complication
2018, Journal of Orthopaedics, Trauma and RehabilitationCitation Excerpt :In rare cases,6 conservative treatment can be successful for undisplaced fracture. Most of the literature supported operative treatment with screws or plates if implant was well fixed and bone fragment was sizable or revision with total knee arthroplasty if implant was loosen or bone fragment was too comminuted.1,3,4,5 Difference in severity of bone defect could occur due to fracture or iatrogenically after implant removal which need to be dealt with either by bone graft or metal wedge.
- 1
No benefits or funds were received in support of this study.