Pertiprosthetic fractures after total knee arthroplasty are challenging to treat. Tibial side are less commonly affected with only few studies and cases reported. We would like to present our patient that presented to us 5 years postoperative in whom revision rotating platform knee surgery was

performed

Bong, Chih How

Jaffar, MSA

Kamaruddin, F.

LIK HAN, ONG

Reuben, P.R

Sabaruddin, A.

Tan, KT

Teh, HL

Unimas Institutional Repository

Periprosthetic fracture of tibia TKA are less commonas compared to femoral/ patella resulting in lessmanagement literature. More often, they areassociated with loose/malaligned implant and bonedeficiencies.Madam F. had Felix et. Al Type II B (inferior tothe tibial plateau adjacent to stem with loosening)fracture in which closed reduction and cast would notresult in good results. In cases with bone loss withwell-fixed prosthesis, internal fixation with lockingplates system is a considerable option.In this case, when tibial component instability(Type B) is present, revision TKA with slotted tibiallong stem is gold standard to fix the implant to thetibial shaft using diaphyseal-engaging stems (DES).The advantages include diaphyseal referencing thathelps component alignment and generallyuncemented at stem level to facilitate removal ifrevision required. The design features of slotted andtitanium also decreases stress at stem tip henceincidence of pain.The concept of “canal-fill-ratio” (CFR) – stemwidth/ intramedullary canal width of more than 0.85with minimal 4cm of diaphyseal fit is recommendedfor stability of uncemented stem.Hybrid construct (cemented tray/ uncementedstem) in our case provides stress transfer of thepatient that bypasses the fracture site to the distaldiaphyseal fixation with no detrimental effect ofbone loss/osteopenia of proximal tibia.DR, I FRACTURED MY PROSTHETIC KNEE 1LH Ong; 2Sabaruddin A; 2Rutel A; 2Jaffar MSA, 2CH Bong; 2KT Tan, 2P. Rao, Reuben, 2HL Teh, 2Kamaruddin F1 Faculty of Medicine & Health Sciences University Malaysia Sarawak Kota Samarahan Sarawak.2Sarawak General Hospital, Kuching Sarawak.INTRODUCTION DISCUSSIONREFERENCESFigure 1: Preoperative radiograph1Figure 2: Postoperative radiograph1: Knee RadiographPertiprosthetic fractures after total kneearthroplasty are challenging to treat. Tibial side areless commonly affected with only few studies andcases reported. We would like to present our patientthat presented to us 5 years postoperative in whomrevision rotating platform knee surgery wasperformed. RevisionMadam F, 65-year-old lady presented with 2 weekshistory of insidious right knee pain, swelling andinstability 5 years post total knee replacement withno evidence of infection. Radiograph notedloosening and peri-prosthetic fracture of the righttibia component associated with fibula neck fracturewith no evidence of biochemistry markers ofinfection.RadiographsCASE REPORTFelix Classification is useful in management ofperiprosthetic tibial fracture post TKA and revisionrotating platform hybrid construct of tibial DES notonly provides stability but also restores mechanicalalignment disregard of metaphyseal bone quality.CONCLUSION1. Patel AR, Barlow B, Ranawat AS. Stem length in revisiontotal knee arthroplasty. Curr Rev Musculoskelet Med.2015;8(4):407-412. doi:10.1007/s12178-015-9297-42. Jae DY, Nam KK, Periprosthetic Fractures Following TotalKnee Arthroplasty. Knee Surg Relat Res 2015;27(1):1-93. NA Felix, Periprosthetic fractures of the tibia associated withtotal knee arthroplasty. Clin Orthop Relat Res. 1997Dec;(345):113-24.

Dr, I Fractured My Prosthetic Knee

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Dr, I Fractured My Prosthetic Knee

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