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Undersizing of the tibial component in Oxford unicompartmental knee arthroplasty (UKA) increases the risk of periprosthetic fractures

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Tibial periprosthetic fractures (TPF) after unicompartmental knee arthroplasty (UKA) are a rare condition that affects about 1% of cases. Known risk factors include age, sex, body mass index (BMI), and bone density, as well as surgical technique and prosthesis design. The purpose of the study was to determine if undersizing of the tibial component in relation to the femoral component increases the risk of tibial periprosthetic fractures.

Material and methods

Over a 6-year-period 1542 patients with cemented (n = 363) and uncemented (n = 1179) medial UKA were retrospectively evaluated. Tibial periprosthetic fractures were identified and classified, and epidemiologic data were documented at follow-up. Undersizing was defined as a smaller tibial component compared to the femoral implant. The association of potential risk factors for TPF with the incidence of TPF was investigated with binominal logistic regression.

Results

Fourteen patients (0.9%) suffered from TPF at a median of 1 month after surgery. The mean follow-up period was 5.9 ± 1.7 years. Fractures were more common in cases with undersized tibial components [odds ratio (OR) 3.2, p < 0.05]. Furthermore, older age (OR 1.1, p < 0.05) and female sex (OR 6.5, p < 0.05) were identified as significant risk factors, while BMI (p = 0.8) and cemented implantation (p = 0.2) had no effect on fracture rate. Revision surgery included open reduction and internal fixation or conversion to total knee arthroplasty.

Conclusions

Undersizing of implant sizes in UKA increases the risk for TPF especially in patients with small tibial implants. Therefore, mismatched implants should be avoided for UKA particularly when risk factors like obesity, older age, or female gender are present. Tibial periprosthetic fractures were successfully treated by open reduction and internal fixation or conversion to total knee arthroplasty.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany

    Julius Watrinet, Philipp Blum, Michael Maier, Steffen Klingbeil, Stephan Regenbogen, Rolf Schipp & Wolfgang Reng

  2. Department Trauma Surgery, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany

    Julius Watrinet, Philipp Blum & Stephan Regenbogen

  3. Institute Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany

    Peter Augat

  4. Institute for Biomechanics, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria

    Peter Augat

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  1. Julius Watrinet
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Contributions

All listed authors have substantially contributed to this study. All the authors have reviewed and confirmed the accuracy of the whole manuscript.

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Correspondence to Julius Watrinet.

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The authors declare that they have one conflict of interest. One author has received benefits for professional or personal use from a commercial party related to a subject of this study.

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Written informed consent was waived by the IRB of the regional Bavarian Medical Association due to the retrospective nature of this study.

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Ethical approval was given by the ethics committee of the Bavarian State Medical Association, Germany (Reference: 2022-1113).

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Watrinet, J., Blum, P., Maier, M. et al. Undersizing of the tibial component in Oxford unicompartmental knee arthroplasty (UKA) increases the risk of periprosthetic fractures. Arch Orthop Trauma Surg 144, 1353–1359 (2024). https://doi.org/10.1007/s00402-023-05142-z

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