Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2015; 6(8): 649-654
Published online Sep 18, 2015. doi: 10.5312/wjo.v6.i8.649
Systematic review of periprosthetic tibia fracture after total knee arthroplasties
Nabil A Ebraheim, Joseph R Ray, Meghan E Wandtke, Grant S Buchanan, Chris G Sanford, Jiayong Liu
Nabil A Ebraheim, Joseph R Ray, Meghan E Wandtke, Grant S Buchanan, Chris G Sanford, Jiayong Liu, Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, United States
Author contributions: Ebraheim NA and Liu J designed the research; Ray JR, Wandtke ME, and Buchanan GS performed the research; Sanford CG and Liu J contributed to analyzing data; Ray JR, Wandtke ME, and Buchanan GS wrote the paper; Ebraheim NA did the proofread.
Conflict-of-interest statement: The authors declare that they have no conflict of interest. No benefits in any form have been received or will be received from any commercial party related directly or indirectly to the subject of this article.
Data sharing statement: Informed consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jiayong Liu, MD, Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH 43614, United States. jiayong.liu@utoledo.edu
Telephone: +1-419-3835361 Fax: +1-419-3833526
Received: February 25, 2015
Peer-review started: February 26, 2015
First decision: May 13, 2015
Revised: June 16, 2015
Accepted: July 29, 2015
Article in press: August 3, 2015
Published online: September 18, 2015
Abstract

AIM: To investigate the known incidences, treatment options, and related outcomes of periprosthetic tibia fractures after total knee arthroplasty (TKA).

METHODS: A literature search was done to identify studies that fit the inclusion criteria. The database search yielded 185 results, which were further reduced by the exclusion criteria to 13 papers, totaling 157 patients that met these criteria. Incidence rates of the different types of periprosthetic tibia fractures were determined and their treatments were subsequently analyzed based on the fracture’s subclass, with patient outcomes being overall favorable.

RESULTS: Of the 144 documented patients, 54 (37.5%) had a subclass C fracture, which are frequently seen in revision arthroplasties or when using cement intraoperatively. The fractures of subclasses A and B occur postoperatively. There were 90 subclass A and B fractures with incidences of 18.75% and 43.75% respectively. When broken down by type, 62 (55.36%) were type 1, 24 (21.4%) were type 2, 24 (21.4%) were type 3, and 2 (1.8%) were type 4. Furthermore, from the studies that included origin of injury, the types were further classified as having non-traumatic or traumatic origins. Type 1 had 78% (40/51) non-traumatic origin and 22% (11/51) traumatic origin. Fifteen fractures were type 2, but 5 were falls and 1 through a motor vehicle accident, giving a trauma causation of 40% (6/15). Of the 24 type 3 fractures, 12 were falls and 2 vehicular accidents, leading to a trauma causation of 58% (14/24).

CONCLUSION: Type 1 fractures were the most common. Subclass A was treated with locking plates, B required a revision TKA, and C was treated intraoperatively or nonoperatively.

Keywords: Periprosthetic fractures, Literature review, Tibia fractures

Core tip: A literature search of the PubMed and Web of Science databases was done to compile the known incidences and treatments of periprosthetic tibia fractures after total knee arthroplasties (TKA). Among the relatively uncommon periprosthetic tibia fracture, type 1 fractures were the most common among documented types. Subclass A fractures were treated with locking plates, subclass B fractures first required a revision TKA, and subclass C fractures were either treated intraoperatively when they occurred or were treated nonoperatively.