Introduction Categories of TKA periprosthetic fractures location distal femur periprosthetic fractures proximal tibia periprosthetic fracture patellar fractures timing intraoperative medial femoral condyle fracture most common postoperative Risk factors (general) poor bone quality age steroid use rheumatoid arthritis stress-shielding mechanical stress-risers screw holes local osteolysis stiffness neurological disorders epilepsy Parkinson's disease cerebellar ataxia myasthenia gravis polio cerebral palsy Distal Femur Periprosthetic Fractures Incidence 0.3%-2.5% Fracture specific risk factors anterior femoral notching (debatable) mismatch of elastic modulus between metal implant and femoral cortex rotationally constrained components Classification systems Lewis and Rorabeck is most commonly used Neer and Associates (1967) Type I Nondisplaced (<5 mm displacement and/or <5 degrees angulation) Type II Displaced > 1 cm Type IIa Displaced > 1 cm with lateral femoral shaft displacement Type IIb Displaced > 1 cm with medial femoral shaft displacement Type III Displaced and comminuted DiGioia and Rubash (1991) Group I Extra-articular, non-displaced (<5 mm and/or <5 degrees angulation) Group II Extra-articular, displaced (>5 mm and/or >5 degrees angulation) Group III Loss of cortical contact or angulated (10 degrees); may have intercondylar or T-shaped component Chen and Associates Classification (1994) Type I Nondisplaced Type II Displaced and/or comminuted Lewis and Rorabeck Classification (1997) Type I Nondisplaced; component intact Type II Displaced: component intact Type III Displaced; component loose or failing Su and Associates' Classification of Supracondylar Fractures of the Distal Femur Type I Fracture is proximal to the femoral component Type II Fracture originates at the proximal aspect of the femoral component and extends proximally Type III Any part of the fracture line is distal to the upper edge of anterior flange of the femoral component Treatment nonoperative casting or bracing indications nondisplaced fractures with stable prosthesis operative antegrade intramedullary nail indications supracondylar fracture proximal to the femoral component (Su Type I) retrograde intramedullary nail technical considerations at least 2 distal interlocking screws use end cap to lock most distal screw if available femoral component may cause starting point to be more posterior than normal and lead to hyperextension at the fracture site nail must be inserted deep enough (not protrude) to not abrade on patella/patellar component indications intact/stable prosthesis with open-box design to accommodate nail fracture proximal to femoral component (Su Type I) fracture that originates at the proximal femoral component and extends proximally (Su Type II) ORIF with fixed angle device indications intact/stable prosthesis Lewis-Rorabeck II or Su Types I or II (described above) unable to accommodate intramedullary device fracture distal to flange of anterior femoral component (Su Type III) techniques condylar buttress plate (non-locking) does not resist varus collapse locking supracondylar / periarticular plate polyaxial screws allow screws to be directed into best bone before locking into plate, and can avoid femoral component blade plate / dynamic condylar screw difficult to get adequate fixation around PS implants complications nonunion increased risk in plating via extensile lateral approach compared with submuscular approach malunion increased risk with minimally-invasive approach/MIPO revision to a long stem prosthesis indications loose femoral component Lewis-Rorabeck III or Su Type III (described above) with poor bone stock distal femoral replacement indications elderly patients with loose (Su type III) or malpositioned components and poor bone stock advantages immediate weight-bearing decreased operative time of procedure Tibial Periprosthetic Fractures Incidence 0.4%-1.7% Fracture specific risk factors prior tibial tubercle osteotomy component loosening component malposition insertion of long-stemmed tibial components Classification Felix and Associates' Classification of Periprosthetic Fractures of the Tibia Associated with TKA Type I Fracture of tibial plateau Type II Fracture adjacent to tibial stem Type III Fracture of tibial shaft, distal to component Type IV Fracture of tibial tubercle Treatment nonoperative casting or bracing indications nondisplaced fracture with stable prosthesis operative ORIF indications unstable fracture with stable prosthesis long-stem revision prosthesis indications displaced fractures with loose tibial component Patellar Periprosthetic Fractures Incidence 0.2%-21% in resurfaced patella 0.05% in unresurfaced patella Fracture specific risk factors patellar osteonecrosis asymmetric resection of patella inappropriate thickness of patella implant related central single peg implant uncemented fixation metal backing on patella inset patellar component Classification Goldberg Classification Type I Fracture not involving implant/cement interface or quadriceps mechanism Type II Fracture involving implant/cement interface and/or quadriceps mechanism Type III Type A: inferior pole fracture with patellar ligament ruptureType B: inferior pole fracture without patellar ligament rupture Type IV All types with fracture dislocations Treatment nonoperative casting or bracing in extension indications stable implants with intact extensor mechanism non-displaced fractures operative indications loose patellar component extensor mechanism disruption techniques (indications for each have not been clearly defined) ORIF with or without component revision partial patellectomy with tendon repair patellar resection arthroplasty and fixation total patellectomy
Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Revision TKR Orthobullets Team Recon - High Tibial Osteotomy Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. TKA - Parapatellar Approach Derek Bernstein Stephen Incavo Recon - High Tibial Osteotomy Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. TKA - Varus Knee with Anterior Referencing and Gap Balancing Technique Derek Bernstein Stephen Incavo Recon - TKA Axial Alignment
QUESTIONS 1 of 19 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.200) A 62-year-old woman is brought to the emergency room after falling down a flight of stairs. Prior to her fall, she had no knee pain and was a community ambulator without assistance. Intraoperatively, it is determined that the implants are well-fixed. What is the best next treatment step to optimize her quality of life? Review Topic QID: 4835 FIGURES: A 1 Closed reduction and long leg casting at 20 degrees of flexion for 6 weeks, followed by hinged-knee brace for 6 weeks. 0% (11/3410) 2 Open reduction and internal fixation with a distal femoral locking plate 91% (3095/3410) 3 Open reduction and internal fixation with a condylar buttress plate 3% (119/3410) 4 Distal femoral replacement arthroplasty 3% (89/3410) 5 Closed reduction and fixation with an antegrade intramedullary nail 2% (74/3410) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 2 (OBQ13.228) A 65-year-old female sustains a periprosthetic supracondylar femur fracture proximal to a well-fixed implant. She undergoes direct reduction and locked plating with a titanium distal femoral locking plate via an extensile lateral approach. At 9 months post-operatively, weightbearing is at 50% and is painful. Examination reveals mild swelling and warmth around the distal incision. Erythrocyte sedimentation rate and C-reactive protein are normal. Radiographs taken 9 months post-operatively are shown in Figure A. Which of the following may have increased the risk of this complication? Review Topic QID: 4863 FIGURES: A 1 Neglecting to add topical rhBMP-2 on a carrier-scaffold 3% (142/4503) 2 Neglecting to use lag screws and cerclage cables 12% (525/4503) 3 Locked plating instead of locked antegrade nailing 5% (231/4503) 4 Use of a titanium plate instead of a stainless steel plate 10% (458/4503) 5 Use of an extensile lateral approach instead of a submuscular approach 69% (3124/4503) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 5 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.94) A 58-year-old woman is seen in the emergency department after falling at home. History reveals that she underwent right total knee arthroplasty 2 years ago. Radiographs are shown in Figures 56a and 56b. What is the most appropriate treatment? Review Topic QID: 6054 FIGURES: A B 1 Closed reduction and casting 0% (0/109) 2 Bed rest and skeletal traction 0% (0/109) 3 Open reduction and internal fixation 69% (75/109) 4 Retrograde intramedullary nailing 3% (3/109) 5 Revision of the femoral component with a stemmed component 28% (31/109) N/A Select Answer to see Preferred Response PREFERRED RESPONSE 3 This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.28) Figure 16 shows the radiograph of an otherwise healthy 62-year-old woman who fell. Management should consist of Review Topic QID: 5988 FIGURES: A 1 revision total hip arthroplasty with a cemented femoral component and adjuvant fracture fixation. 15% (15/98) 2 revision total hip arthroplasty with a cementless femoral component and adjuvant fracture fixation. 72% (71/98) 3 open reduction and internal fixation of the fracture and retention of the original components. 9% (9/98) 4 removal of the components, open reduction and internal fixation of the fracture, and delayed replantation of the components when the fracture is healed. 2% (2/98) 5 resection arthroplasty and internal fixation of the fracture. 1% (1/98) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 2 This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.9) A 75-year-old woman who fell on her right knee now reports pain and is unable to bear weight. History reveals that she underwent total knee arthroplasty on the right knee 6 years ago. Radiographs are shown in Figure 5. Management should now consist of Review Topic QID: 5969 FIGURES: A 1 closed reduction and casting for 6 weeks. 1% (1/159) 2 open reduction and internal fixation, using a locked intramedullary rod. 1% (1/159) 3 open reduction and internal fixation, using two cancellous screws. 3% (5/159) 4 open reduction and internal fixation, using a locked plate and screws. 19% (31/159) 5 open reduction and internal fixation and revision of the femoral component. 73% (116/159) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 5 (OBQ05.153) All of the following are risk factors for post-operative total knee arthroplasty periprosthetic supracondylar femur fractures EXCEPT: Review Topic QID: 1039 1 Rheumatoid arthritis 7% (71/986) 2 Parkinson's disease 8% (78/986) 3 Chronic steroid therapy 1% (13/986) 4 Revision knee arthroplasty 4% (37/986) 5 Male gender 79% (780/986) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 5 (OBQ05.100) A 73 year-old female underwent total knee arthroplasty 10 years ago. She sustained a proximal tibial shaft periprosthetic fracture after a ground level fall. Radiographs show that the fracture involves the tibial component's stem with loosening of the tibial component. Which of the following is the most appropriate treatment? Review Topic QID: 986 1 Open reduction and internal fixation of the tibia 1% (32/2206) 2 External fixation 0% (3/2206) 3 Intramedullary rod fixation 0% (2/2206) 4 Revision with a long stem tibial component that bypasses the fracture 98% (2161/2206) 5 Fracture bracing 0% (5/2206) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 4
2018 Orthopaedic Summit Evolving Techniques Evolving Technique Update: 78-Year-Old Female, Heard A Crack Around Her Thigh 1 Year After Her Total Knee Replacement - My Treatment Algorithm - Michael B. Cross, MD (OSET 2018) Michael Cross Recon - TKA Periprosthetic Fracture 3 weeks ago 171 views
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