How to optimize patellar tracking in knee arthroplasty?

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

[Indexed for MEDLINE] 14. J Knee Surg. 2021 Oct;34(12):1269-1274. doi: 10.1055/s-0040-1708037. Epub 2020 May 27. Intraoperative Proximal Tibia Periprosthetic Fractures in Primary Total Knee Arthroplasty. Damsgaard CW(1), Gad BV(2), Bono OJ(3), Anderson MC(3), Brown JM(4), Bono JV(4), Talmo CT(4). Author information: (1)Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania. (2)Department of Orthopedic Surgery, Sports and Orthopaedic Specialists, Edina, Minnesota. (3)Department of Research, New England Baptist Hospital, Boston, Massachusetts. (4)Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts. Intraoperative fracture of the proximal tibia is a rare complication of total knee arthroplasty (TKA) with few studies available reporting risk factors or prognosis. A review of our prospective joint registry was performed to determine the incidence and associated risk factors of intraoperative tibia fractures during primary TKA; 14,966 TKAs of all manufacturers were performed with 9 intraoperative tibia fractures. All fractures occurred in a single TKA design. There were 8,155 TKAs of this design performed with a fracture incidence of 0.110%. All but one fracture occurred on the medial tibial plateau, and all but one occurred during preparation of the tibia with keel punching. A control group of 75 patients (80 knees) with the same TKA design were randomly selected. Baseplates size 3 or smaller were less likely to experience an intraoperative fracture (odds ratio [OR]: 0.864, 95% confidence interval [CI]: 0.785-0.951), as were knees with a polyethylene insert thickness of 13 mm or larger (OR: 0.882, 95% CI: 0.812-0.957). Fractures were treated with a variety of different methods, but every patient had at least one screw placed and most (67%) had postoperative weight-bearing restrictions. At final follow-up, there were no cases of nonunion, component subsidence, or need for reoperation. Intraoperative tibia fractures are a rare complication of this TKA design at 0.11%. Knees with baseplates of size ≤3 and polyethylene thickness ≥13 mm were less likely to experience intraoperative fracture. These findings may be related to the depth of tibial resection, requiring the use of a thicker polyethylene insert, and a change in the keel width in implants size 4 or larger. No fracture patients required reoperation. Thieme. All rights reserved. DOI: 10.1055/s-0040-1708037