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Treatment of periprosthetic fractures after total knee arthroplasty

Periprosthetic fracture is a relatively rare complication after total knee arthroplasty. As the prevalence of total knee arthroplasty increases, however, the incidence of periprosthetic fractures is increasing concomitantly. The treatment of periprosthetic fractures about the knee is expected to become a more frequent challenge for practicing orthopaedic surgeons. The distal femur is the most common site for a periprosthetic fracture about total knee arthroplasty components (0.3–4.2%); periprosthetic fractures of the patella (0.7–1.8%) and proximal tibia (0.4–0.5%) occur to a lesser degree. Periprosthetic fractures are associated with significant morbidity and mortality and can be technically challenging to treat. Stable fractures in the presence of stable implants can be treated nonoperatively. Unstable fractures in the presence of stable implants are best treated with open reduction and internal fixation, whereas those associated with implant loosening require revision arthroplasty. Open reduction and internal fixation often are complicated by decreased bone density and fracture patterns where limited bone is available for fixation. The present article focuses on the treatment of periprosthetic fractures about stable total knee arthroplasty components that do not require revision arthroplasty.