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BONE GROWTH ENHACING FACTORS
Thomas J. Moore
Emory University. Scool of Medicine Atlanta,
Georgia (USA)
MANAGEMENT OF PERIPROSTHETIC
FRACTURES IN TOTAL KNEE
ARTHROPLASTY
E. Carlos Rodríguez-Merchán, MD, PhD
Department of Orthopaedics, La Paz University Hospital,
Madrid, (Spain)
INTRODUCTION
When a treatment option is chosen in a peri-prosthetic fracture
of the knee, consideration must be given to multiple factors
including:
- The status of the prosthetic fixation
- The degree of comminution of the fracture
- The proximity of the fracture to the prosthetic component
- The longitudinal alignment of the limb
- The degree of displacement of the fracture (table 1)
- The extent of osteoporosis
Table 1. Classification of periprosthetic supracondylar
fractures (Rorabeck et al, Instr Course Lect 1998;
47:449-458)
Type 1 Undisplaced fracture – Prosthesis stable
Type 2 Displaced fracture – Prosthesis stable
Type 3 Displaced or undisplaced fracture – Prosthesis
loose or failing
TYPES OF BONE FIXATION
- Rush rods plus cement
- Condylar blade-plate
- Supracondylar locked rod
- LISS (better, if rapid mobilization is needed
TREATMENT OF TYPE 3 FRACTURES
A displaced or undisplaced supracondylar fracture adjacent
to a loose or failing total knee implant (type 3 fracture) can
be treated in one of two ways: like a displaced supracondylar
fracture (type 2 fracture), with revision of the implant at a
later date, or with revision of the implant as part of the fracture
stabilization.
If the surgeon performs a revision, the implant should be
replaced with a long-stemmed femoral component, a custommade
component or tumor prosthesis, or an allograft-implant
composite that also replaces the damaged distal aspect of
the femur.