Periprosthetic Femoral Supracondylar Fracture After Total Knee Arthroplasty With Navigation System

doi:10.1016/j.arth.2006.12.049

The Journal of Arthroplasty

Volume 23, Issue 2, February 2008, Pages 304-307

https://doi.org/10.1016/j.arth.2006.12.049 Get rights and content

Abstract

We report 1 patient with a supracondylar periprosthetic fracture 1 month after computer-assisted total knee arthroplasty. The fracture line extended from previous anchoring pinholes into the supracondyle area. Intramedullary nailing of the left femur was performed under close reduction. The possible complication of pinhole fracture to total knee arthroplasty with navigation system should be kept in mind.

Section snippets

Case Report

The patient was a 53-year-old woman with left knee osteoarthritis. She was admitted to the authors' institution in February 2006. She complained of gross swelling, marked pain, and limited motion of the left knee. Past medical illnesses included hypertension, hyperlipidemia, and chronic renal insufficiency and were under regular medication control. She received right TKA 4 years ago. She was 147 cm in height and 80 kg in weight; her body mass index was 37.0. Physical examination at admission

Discussion

The first 2 reports of femoral supracondylar fractures associated with TKA were published in 1981 2, 3. The incidence ranged from 0.3% to 2.5% in the literatures 4, 5, 6, 7, 8, 9, 10. However, the elderly and osteoporotic population is rapidly increasing, and this possible risk of TKA should be given attention.

The mechanism of injury in periprosthetic fracture is usually a low-energy trauma, with the combination of abnormal axial and torsional loads. However, some other risk factors have been

References (24)

F. Chen et al.
Management of ipsilateral supracondylar femur fractures following total knee arthroplasty
J Arthroplasty
(1994)
M.P. Figgie et al.
The results of treatment of supracondylar fracture above total knee arthroplasty
J Arthroplasty
(1990)
M.A. Ritter et al.
Anterior femoral notching and ipsilateral supracondylar femur fracture in total knee arthroplasty
J Arthroplasty
(1988)
J.C. Behiri et al.
Orientation dependence of the fracture mechanics of cortical bone
J Biomech
(1989)
D. Ralf et al.
Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation
J Arthroplasty
(2005)
D.M. Hirsh et al.
Supracondylar fracture of the femur following total knee replacement
J Bone Joint Surg Am
(1981)
W.H. Short et al.
Ipsilateral supracondylar femur fractures following knee arthroplasty
Clin Orthop
(1981)
D.C. Ayers et al.
Common complications of total knee arthroplasty
J Bone Joint Surg Am
(1997)
D.C. Ayers
Supracondylar fractures of the distal femur proximal to a total knee replacement
Instr Course Lect
(1997)
M.J. Chmell et al.
Periarticular fractures after total knee arthroplasty: principles of management
J Am Acad Orthop Surg
(1996)

W.L. Healy et al.

Operative treatment of distal femoral fractures proximal to total knee replacements

J Bone Joint Surg Am

(1993)

K.D. Merkel et al.

Supracondylar fracture of the femur after total knee arthroplasty

J Bone Joint Surg Am

(1986)

Cited by (68)

Pin-Related Complications in Computer Navigated and Robotic-Assisted Knee Arthroplasty: A Systematic Review
2022, Journal of Arthroplasty
Computer-assisted navigation (CAN) and robotic-assisted (RA) knee arthroplasty procedures carry unique risks of tracking pin-related complications. This systematic review aimed to quantitatively assess the incidence, timing, treatment, and clinical outcomes of all tracking pin-related complications following CAN and RA knee arthroplasty.
A systematic review was performed using PubMed, Cochrane Central and Scopus databases. All clinical studies that documented pin-related complications associated with the use of CAN or RA for total or partial knee arthroplasty were included. Descriptive statistics were analyzed when data were available.
Thirty-six studies were included: 18 case reports (25 cases) and 18 randomized controlled trials, cohort studies and case series i.e., non-case reports (7,336 cases). The most common pin-related complication among case reports was fracture (n = 22; 81%). The overall rate of pin-related complications among non-case reports was 1.4%. The intraoperative and postoperative complication with the highest incidence were pin dislodgement (0.6%) and superficial pin site infections (0.6%), respectively. Most postoperative complications were related to the tibial site (69%). All complications were effectively treated and resolved at follow-up.
Pin-related complications following CAN and RA knee arthroplasty are relatively uncommon. While pin loosening, superficial infections and fractures have been most commonly documented, other complications such as vascular injury, myositis ossificans, and osteomyelitis can also occur. The potential for pin-related complications should be considered by arthroplasty surgeons, especially during early stages of adoption. Further studies investigating patient risk factors for pin-related complications are warranted.
Adverse Events Associated With Robotic-Assisted Joint Arthroplasty: An Analysis of the US Food and Drug Administration MAUDE Database
2022, Journal of Arthroplasty
Citation Excerpt :
Finally, in a randomized controlled trial with a minimum follow-up of 10 years, there was no difference in complication rates between robotic-assisted and conventional TKA [7]. Although broader postoperative complication rates following robotic-assisted arthroplasty appear comparable to manual surgery, complications specific to the use of computer-assisted navigation and robotic assistance have been reported and remain a risk not typically applicable to conventional TJAs performed without the use of these technologies [19–23]. Modern robotic-assisted arthroplasty systems typically require multiple bone pins to be temporarily placed either within the surgical field or through separate percutaneous incisions (2 femoral and 2 tibial pins for TKA, 2-3 pelvic pins for THA).
The use of robotic assistance in arthroplasty is increasing; however, the spectrum of adverse events potentially associated with this technology is unclear. Improved understanding of the causes of adverse events in robotic-assisted arthroplasty can prevent future incidents and enhance patient outcomes.
Adverse event reports to the US Food and Drug Administration Manufacturer and User Facility Device Experience database involving robotic-assisted total hip arthroplasty (THA), total knee arthroplasty (TKA), and partial knee arthroplasty were reviewed to determine causes of malfunction and related patient impact.
Overall, 263 adverse event reports were included. The most frequently reported adverse events were unexpected robotic arm movement for TKA (59/204, 28.9%) and retained registration checkpoint for THA (19/44, 43.2%). There were 99 reports of surgical delay with an average delay of 20 minutes (range 1-120). Thirty-one cases reported conversion to manual surgery. In total, 68 patient injuries were reported, 7 of which required surgical reintervention. Femoral notching (12/36, 33.3%) was the most common for TKA and retained registration checkpoint (19/28, 67.9%) was the most common for THA. Although rare, additional reported injuries included femoral, tibial, and acetabular fractures, MCL laceration, additional retained foreign bodies, and an electrical burn.
Despite the increasing utilization of robotic-assisted arthroplasty in the United States, numerous adverse events are possible and technical difficulties experienced intraoperatively can result in prolonged surgical delays. The events reported herein seem to indicate that robotic-assisted arthroplasty is generally safe with only a few reported instances of serious complications, the nature of which seems more related to suboptimal surgical technique than technology. Based on our data, the practice of adding registration checkpoints and bone pins to the instrument count of all robotic-assisted TJA cases should be widely implemented to avoid unintended retained foreign objects.
Trends of Utilization and 90-Day Complication Rates for Computer-Assisted Navigation and Robotic Assistance for Total Knee Arthroplasty in the United States From 2010 to 2018
2021, Arthroplasty Today
Computer-assisted navigation (CAN) and robotic assistance (RA) for total knee arthroplasty (TKA) are gaining in popularity. The purpose of this study is to update the literature on United States technology-assisted TKA trends of national utilization, regional utilization, and 90-day complication rates requiring readmission.
Patients who underwent primary, elective TKA between 2010 and 2018 were retrospectively identified in the PearlDiver All Payer Claims Database (PearlDiver Technologies Inc.). TKAs were classified as conventional, CAN, or RA based on International Classification of Diseases nineth or tenth revision and Current Procedural Technology codes. Annual rates and regional trends of each type of TKA were reported. Ninety-day complications requiring readmission for each group were captured. Multivariable logistic regression was used to identify odds ratios (OR) for all-cause readmission based on TKA modality.
Of the 1,307,411 elective TKAs performed from 2010 to 2018, 92.8% were conventional, and 7.7% were technology-assisted (95.2% CAN and 4.9% RA). RA-TKA had the greatest increase in utilization (+2204%). The Western region had the highest utilization of technologies for TKA, while the Midwestern region had the lowest. Ninety-day postoperative complications requiring readmission were highest for conventional TKA and lowest for RA-TKA. RA-TKA (OR 0.68; 97.5% confidence interval 0.56-0.83, P < .001) and CAN-TKA (OR 0.93; 97.5% confidence interval 0.88-0.97, P < .05) had significantly lower odds of all-cause 90-day complications requiring readmission than conventional TKA.
Utilization of RA-TKA and CAN-TKA continues to rise across the United States. The use of these technologies is associated with a lower OR of readmission within 90 days postoperatively.
A comparison of two different navigated hip replacement techniques on leg length discrepancy
2018, Journal of Orthopaedics
Citation Excerpt :
One of these arrays was placed in the distal femur. These pins have the theoretical risk of infection, fracture and post-operative discharge.27–30 This led to the development of a pinless reference system which uses external reference markers that are placed on the skin.
We hypothesised that a femoral array placed into bone or an external (pinless) reference marker made no difference to leg length discrepancy in patients undergoing navigated total hip arthroplasty. Consecutive patients undergoing navigated total hip arthroplasty. 162 patients. No statistical difference between preoperative leg length discrepancy (p = 0.524). Mean intraoperative change was 3.7 mm and 4.6 mm (p = 0.262). The mean change in leg length measure post operatively was 4.2 mm and 4.1 mm (p = 0.656). No significant difference in leg length discrepancy between a pinless reference markers and a femoral array placed into the bone.
Morbidity and Safety of Iliac Crest Reference Array Pins in Navigated Total Hip Arthroplasty: A Prospective Cohort Study
2018, Journal of Arthroplasty
Navigated total hip arthroplasty (THA) can employ intra-osseous pins through a separate incision to secure reference arrays to the iliac crest. This study is the first to investigate the consequences of pin use in THA in vivo.
A prospective, consecutive series of 43 patients presenting for navigated THA were included. Two temporary 125 × 4 mm Schanz screws were inserted into the iliac crest for the attachment of a reference array. Telephone follow-up occurred at 6 and 12 weeks post-operatively. Patients were asked about pain, interference with daily activities, how often the wound was noticed, and duration of discomfort. Patient body mass index was recorded.
The follow-up rate was 100%. Pin site pain at any time post-operatively was reported by 24 patients (56%). This improved to 30%, 9%, and 2% at 3, 6, and 12 weeks, respectively. On average, pain lasted for 16 days total. The most common complaints after pain were clothing discomfort (23%), pain when wearing a belt (12%), or pain when mobilizing (9%). For the majority (98%) of patients, all symptoms had resolved by 12 weeks. There was no nerve injury, pin site fracture, infection, or screw breakage. Patients with body mass index greater than 30 kg/m² were up to 3 times more likely to experience pin site pain (P = .05), and had a longer duration of pain (P = .04).
Surgeons and patients should be aware that using navigational pins for array fixation carries low complication rates but often will cause pain and irritation that resolves in the short term.
Three-dimensional analysis of accuracy of patient-matched instrumentation in total knee arthroplasty: Evaluation of intraoperative techniques and postoperative alignment
2017, Journal of Orthopaedic Science
It is questionable that the accuracies of patient-matched instrumentation (PMI) have been controversial, even though many surgeons follow manufacturers' recommendations. The purpose of this study was to evaluate the accuracy of intraoperative procedures and the postoperative alignment of the femoral side using PMI with 3-dimensional (3D) analysis.
Eighteen knees that underwent total knee arthroplasty using MRI-based PMI were assessed. Intraoperative alignment and bone resection errors of the femoral side were evaluated with a CT-based navigation system. A conventional adjustable guide was used to compare cartilage data with that derived by PMI intraoperatively. Postoperative alignment was assessed using a 3D coordinate system with a computer-assisted design software. We also measured the postoperative alignments using conventional alignment guides with the 3D evaluation.
Intraoperative coronal alignment with PMI was 90.9° ± 1.6°. Seventeen knees (94.4%) were within 3° of the optimal alignment. Intraoperative rotational alignment of the femoral guide position of PMI was 0.2° ± 1.6°compared with the adjustable guide, with 17 knees (94.4%) differing by 3° or less between the two methods. Maximum differences in coronal and rotation alignment before and after bone cutting were 2.0° and 2.8°, respectively. Postoperative coronal and rotational alignments were 89.4° ± 1.8° and −1.1° ± 1.3°, respectively. In both alignments, 94.4% of cases were within 3° of the optimal value. The PMI group had less outliers than conventional group in rotational alignment (p = 0.018).
Our 3D analysis provided evidence that PMI system resulted in reasonably satisfactory alignments both intraoperatively and postoperatively. Surgeons should be aware that certain surgical techniques including bone cutting, and the associated errors may affect postoperative alignment despite accurate PMI positioning.

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: No benefits or funds were received in support of the study.

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Case ReportPeriprosthetic Femoral Supracondylar Fracture After Total Knee Arthroplasty With Navigation System

Abstract

Section snippets

Case Report

Discussion

J Arthroplasty

J Arthroplasty

J Arthroplasty

J Biomech

Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation

J Arthroplasty

Supracondylar fracture of the femur following total knee replacement

J Bone Joint Surg Am

Ipsilateral supracondylar femur fractures following knee arthroplasty

Clin Orthop

Common complications of total knee arthroplasty

J Bone Joint Surg Am

Supracondylar fractures of the distal femur proximal to a total knee replacement

Instr Course Lect

Periarticular fractures after total knee arthroplasty: principles of management

J Am Acad Orthop Surg

Operative treatment of distal femoral fractures proximal to total knee replacements

J Bone Joint Surg Am

Supracondylar fracture of the femur after total knee arthroplasty

J Bone Joint Surg Am

Case Report
Periprosthetic Femoral Supracondylar Fracture After Total Knee Arthroplasty With Navigation System