Peri-prosthetic trans-patellar fractures after Total knee Arthroplasty: a case series and review of literature
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Govil et al. Arthroplasty (2020) 2:35 https://doi.org/10.1186/s42836-020-00050-8
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Peri-prosthetic trans-patellar fractures after Total knee Arthroplasty: a case series and review of literature Gaurav Govil1,2* , Lavindra Tomar1,3 and Pawan Dhawan1,4
Abstract: Peri-prosthetic patella fracture is the second most common peri-prosthetic fracture after total knee arthroplasty. This report presented the treatment results in 6 patients with peri-prosthetic patella fractures. From January 2015 to February 2019, six patients with peri-prosthetic patella fractures were treated. The mean age at surgery was 64 years (range, 48–72 years). Four patients with displaced fractures were treated surgically, and two patients with non-displaced fractures were treated non-surgically. Outcomes were assessed in terms of motion, functional knee score, and Knee Society score. The mean follow-up period lasted 16 months (range: 12–20 months). The average arc of motion was 110° (range: 80°–130°). The mean functional knee score was 77 (range: 70–87). The mean Knee Society score was 84 (range: 75–89). The non-surgical treatment may be a good choice for non-displaced peri-prosthetic patella fractures. For displaced fractures, surgical treatments yielded good functional outcomes. Level of evidence: IVa Keywords: Peri-prosthetic patella fracture, Patella, Osteosynthesis, Complication, Trans-patellar fracture
Introduction Peri-prosthetic patella fracture (PPPF) represents the second most common peri-prosthetic fracture after total knee arthroplasty (TKA). The reported prevalence rates stood somewhere between 0.2–21% in resurfaced patellae and was about 0.5% in un-resurfaced patellae [1–5]. Most PPPFs occur within 2 years after arthroplasty. Treatments include non-surgical and surgical methods, depending on the features of fractures [2, 4]. Currently, there is no universally-accepted validated classification system for PPPFs. The Ortiguera and Berry classification is most commonly used. It takes into account both stability of patellar implant and the extensor mechanism [6]. Goldberg et al [7] also developed a classification on the basis of extensor apparatus continuity and stability of patella resurfacing. However, this classification does not consider variability of fracture configuration and * Correspondence: [email protected] 1 Department of orthopaedics, Max Super Speciality Hospital, 108 A, I.P. Extension, Patparganj, Delhi 110092, India 2 D-101, Sunshine Helios, Sector 78, Noida, Uttar Pradesh 201305, India Full list of author information is available at the end of the article
involvement of quadriceps tendon. Trans-patellar fractures with stable implant and intact extensor mechanism can be treated non-surgically [8]. On the other hand, displaced trans-patellar fractures require open reduction and internal fixation [5]. Patellar fractures with unstable implant require a revision arthroplasty. This report introduced the treatments of PPPFs, with a review of the literature conducted.
Patients and methods Informed co
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