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Atraumatic Fracture of the Medial Femoral Condyle of a Total Knee Arthroplasty.

ABSTRACT: The fracture of the femoral component is a rare complication of a total knee arthroplasty (TKA). This article presents a case in which a 70-year-old man underwent a left press-fit Advance Medial-Pivot Knee System TKA (MicroPort Orthopedics, Arlington, TN) in 2000. Twenty years later, he experienced a nontraumatic onset of knee pain after standing up from a lunge position. Radiographs and CT scans revealed a complete fracture of the medial condyle of the femoral component. Revision surgery was performed confirming the broken component. A cemented Triathlon Total Stabilizer (Stryker Orthopedics, Kalamazoo, MI) prosthesis was used for the revision. The authors recommend that surgeons maintain a high level of suspicion of component fracture when patients present with persistent severe knee pain and instability after a TKA.

SUBMITTER: Ocampo R

PROVIDER: S-EPMC8079325 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Atraumatic Fracture of the Medial Femoral Condyle of a Total Knee Arthroplasty.

Ocampo Ricardo R Azua Eric E Presti Matthew M Voss Lynn L

Arthroplasty today 20210414

The fracture of the femoral component is a rare complication of a total knee arthroplasty (TKA). This article presents a case in which a 70-year-old man underwent a left press-fit Advance Medial-Pivot Knee System TKA (MicroPort Orthopedics, Arlington, TN) in 2000. Twenty years later, he experienced a nontraumatic onset of knee pain after standing up from a lunge position. Radiographs and CT scans revealed a complete fracture of the medial condyle of the femoral component. Revision surgery was pe ...[more]

PMID: 33937462

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Project description:PurposeThe anterior flange height of the current femoral component increases with an increasing distal femoral anteroposterior dimension. During total knee arthroplasty (TKA), we have observed that a large femur may have a thinner anterior condyle, whereas a small femur may have a thicker anterior condyle. The first purpose of this study was to examine whether the femoral anterior condyle height decreases as the distal femoral anteroposterior size increases and whether gender differences exist in anterior condyle height.MethodsA total of 1218 knees undergoing TKA intraoperative and computed tomography scans from 303 healthy knees were used to measure the anterior lateral condylar height (ALCH), anterior medial condylar height (AMCH), and the lateral anteroposterior (LAP) and medial anteroposterior (MAP) dimensions of distal femurs. The LAP and MAP measurements were used for adjustments to determine whether gender differences exist in anterior condyle heights. Linear regression analysis was performed to determine correlations between ALCH and LAP or between AMCH and MAP.ResultsThere were significant differences between males and females in ALCH in both the CT and TKA groups and AMCH in the CT group (all P<0.01). After adjusting for LAP and MAP, there were significant gender differences in the lateral and medial condylar heights in both groups (P<0.01). There were significant negative correlations between ALCH and LAP values and between AMCH and MAP values in both CT and TKA measurements, with the LAP and MAP values increasing as ALCH and AMCH decreased.ConclusionsThe results demonstrate that femoral anterior condylar height decreased with increasing anteroposterior dimension in both the medial and lateral condyle. In addition, this study also showed that anterior condylar heights are highly variable, with gender differences. The data may provide an important reference for designing femoral anterior flange thickness to precisely match the natural anterior condylar anatomy.

Project description:PurposeStability in the sagittal plane, particularly regarding anterior cruciate ligament compensation, and postoperative functionality and satisfaction remain issues in total knee arthroplasty. Therefore, this prospective study compared the clinical outcomes between medial-pivot-based and posterior-stabilised total knee arthroplasty based on anterior translation and clinical scores.MethodsTo assess outcomes of total knee arthroplasty for varus osteoarthritis, the anterior translation distance of the tibia relative to the femur was measured at 30 and 60° of flexion using a KS measure Arthrometer at 6 months postoperatively. The 2011 Knee Society Score, Forgotten Joint Score, visual analogue scale for pain, and range of motion were assessed at 6 months and 1 year postoperatively. The correlations among each score, anterior translation distance, range of motion, and visual analogue scale score for pain were investigated.ResultsThe medial-pivot and posterior-stabilised groups comprised 70 and 51 patients, respectively. The medial-pivot group exhibited a significantly shorter anterior translation distance at 60° flexion than the posterior-stabilised group. Furthermore, the medial-pivot group achieved significantly better outcomes regarding the visual analogue scale for pain, 2011 Knee Society Score, and Forgotten Joint Score than the posterior-stabilised group. A significant negative correlation was observed between the anterior translation distance and the function score of the 2011 Knee Society Score, whereas a significant positive correlation was found between the anterior translation distance and flexion angle, and between the extension angle and score of the Forgotten Joint Score or 2011 Knee Society Score. Significant negative correlations were also found between the pain visual analogue scale and both the 2011 Knee Society Score and Forgotten Joint Score.ConclusionIn total knee arthroplasty for osteoarthritis, the medial-pivot group displayed a shorter anterior translation distance than the posterior-stabilised group at 6 months postoperatively. The visual analogue scale score for pain was also significantly lower in the medial-pivot group than that in the posterior-stabilised group at both 6 months and 1 year postoperatively. Because a correlation was observed between the anterior translation distance and the function score, medial-pivot-based total knee arthroplasty was considered to significantly improve postoperative function compared to posterior-stabilised total knee arthroplasty.

Dataset Information

Atraumatic Fracture of the Medial Femoral Condyle of a Total Knee Arthroplasty.

Publications

Atraumatic Fracture of the Medial Femoral Condyle of a Total Knee Arthroplasty.

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