Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2012 Jan;25(1):1-7. Korean.
    Published online Jan 31, 2012.
    https://doi.org/10.12671/jkfs.2012.25.1.1
    Copyright © 2012 The Korean Fracture Society
    Original Article

    Risk Factors of Periprosthetic Fracture after Total Knee Arthroplasty

    Ju-Young Shin, M.D., Hyung-Jun Kim, M.D., Seung-Han Cha, M.D. and Dong-Heon Kim, M.D.
      • Department of Orthopaedic Surgery, College of Medicine, Konkuk University, Chungju, Korea.
    • Address reprint requests to: Dong-Heon Kim, M.D. Department of Orthopaedic Surgery, College of Medicine, Konkuk University, 620-5, Kyohyun-dong, Chungju 380-704, Korea. Tel: 82-43-840-8250, Fax: 82-43-844-7300, Email: kdkim@kku.ac.kr
    Received March 01, 2011; Revised May 31, 2011; Accepted November 22, 2011.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    To evaluate the incidence rate and risk factors for periprosthetic fracture after total knee replacement (TKR).

    Materials and Methods

    We carried out a retrospective case-control study of 596 patients (951 knees) who underwent TKR between 1999 and 2006 and who were followed up over 36 months. We classified patients into group I (study group) and group II (control group). We subdivided risk factors as pre-operative, intra-operative, and post-operative factors. Age, osteoporosis, revision arthroplasty, CVA, and alcohol dependence were categorized as pre-operative factors; anterior femoral notching and prosthetic types (mobile, fixed, and load-bearing) were considered intra-operative factors; and post-operative activity level was classified as a post-operative factor. We obtained information from the patients' charts, X-ray film, and telephone interviews.

    Results

    The overall incidence rate was 2.25%; 3 patients were male, and 18 were female (14.28% and 85.72%, respectively). Old age (p<0.01, odds ratio=1.14), osteoporosis (p=0.01, odds ratio=4.74), revision arthroplasty (p=0.01, odds ratio=7.46), CVA (p=0.02, odds ratio=8.55), and alcohol dependence (p=0.03, odds ratio=44.54) were statistically significant among the pre-operative factors. Among the intra-operative factors, anterior femoral notching (p<0.01, odds ratio=11.74) was significant, and continued heavy labor (p<0.01, odds ratio=8.14) was significant among the post-operative factors.

    Conclusion

    We concluded that old age, osteoporosis, revision arthroplasty, comorbidity related with falling down, anterior femoral notching, and continued heavy labor were associated with periprosthetic fracture after TKR.

    Keywords
    Risk factor; Periprosthetic fracture; Total knee replacement

    Figures

    Fig. 1
    (A) Tansverse sections of the distal femur showing notching.

    (B) Sagittal section of the distal femur demonstrating grade III and IV notching.

    Tables

    Table 1
    UCLA activity-level rating system

    Table 2
    The cause of periprosthetic supracondylar fracture

    Table 3
    Summary of patient's data

    Table 4
    Risk factors by Multi-variable logistic regression

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    MeSH Terms
    Alcoholism
    Arthroplasty
    Arthroplasty, Replacement, Knee
    Case-Control Studies
    Comorbidity
    Female
    Humans
    Incidence
    Knee
    Male
    Osteoporosis
    Periprosthetic Fractures
    Retrospective Studies
    Risk Factors
    Telephone
    X-Ray Film
    Metrics
    Share
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    Tables
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