Treatment And Curative Effect Analysis Of Periprosthetic Fracture After Total Knee Arthroplasty

Objective:To investigate the treatment method and effect of periprosthesis fracture after total knee arthroplasty.Materials and Methods:The data of 20 patients with PPF after knee arthroplasty admitted to the Department of Orthopaedics and Joint Surgery of the First Hospital of Bethune,Jilin University from January 2010 to January 2021 were retrospectively analyzed.The average age of the patients was(64.3±7.99)years.There were 6 males and 14 females.The reasons for the primary replacement were osteoarthritis in 13 cases and rheumatoid arthritis in 7 cases.There were16 cases of broken bones in fall and 4 cases in traffic accident.7 on the left and 13 on the right.Fracture classification Rhee 17 knees,Felix 2 knees,Roth 1 knees.There were 10 cases of osteoporosis,4 cases of hypertension,1 case of valvular heart disease,and 4 cases of diabetes mellitus.The time interval between fracture occurrence and primary knee arthroplasty or revision was(4.33±4)years on average.For different subtypes,different surgical methods were used,such as plate,intramedullary nail and revision surgery.The operative time,blood loss,hospital stay,knee X-ray,knee HSS score and fracture healing were observed and recorded.Results:Among the 20 patients,1(PPF patellar fracture Roth I type after TKA)was lost to follow-up(5%).Nineteen patients were followed up for 0.5 ~ 10 years,with an average follow-up time of(3.9±2.77)years.The operative time was 1.5 ~ 6 hours(mean(3±1.00)hours).The intraoperative blood loss was 100 ~ 800mlml(mean(315±187.15)ml).The hospitalization days of 20 patients ranged from 6 to 34 days,and the average hospitalization days were(16.05±7.56)days.A total of 19 patients were followed up at the last follow-up,and the average HSS score of the 19 patients was 86.75±7.78 points,among which the highest HSS score was 90.50±2.12 points for the tibial Felix I fracture around the knee prosthesis,and the lowest(72.33±2.52)points for the femoral Rhea IV fracture.HSS score of hip joint was 13 knees excellent and 6 knees good.There were statistically significant differences in knee HSS score and healing time between different subtypes(P < 0.05).There was no statistical difference in the operative time,the amount of blood loss and the length of hospitalization between different types of treatment.Claudication was found in 18 cases(94.73%)without claudication and 1 case(5.27%)with mild claudication.As for walking function,16 cases(84.21%)walked autonomously and 3 cases(15.79%)were walking AIDS.Among them,1 patient(5.27%)was limited to indoor walking,6 patients(31.57%)had a walking distance greater than 1 km,and 12 patients(63.16%)had no walking distance restriction.As for daily living function,15 patients(78.94%)could work from light physical labor,and 4 patients(21.05%)could take care of themselves in daily life.There was statistical difference in knee HSS score between different surgical methods(P < 0.05),and RIMN had the highest HSS score(89.50±2.12 on average).The revision was in the middle(88.60±2.97);The LCP was the lowest(81.08±6.93).The fracture healing time of 19 patients was 3-7 months(4.60±1.27)months on average.The healing time of different fracture types was the shortest 3 months for Felix type I fracture and the longest(5.67±0.58)months for Rhee type IV fracture.The fracture healing time of different types was statistically significant(P < 0.05).There was no statistical difference in the healing time between the two groups in the surgical method(P>0.05).Conclusion:(1)The formulation of treatment strategies for periprosthetic fractures after artificial knee replacement should take into account the fracture site,the nature of the fracture,the stability of the prosthesis,the bone destruction,the patient’s age,physical conditions and economic status.(2)The selection of surgical methods for the lateral femoral fracture around the knee prosthesis according to Rhee classification can obtain a better recovery.(3)Through comprehensive comparative analysis,if the fracture end is unstable,the bone mass is good,and the prosthesis is stable,the therapeutic effect of intramedullary nail is better than that of plate;Revision surgery has certain advantages in the case of poor bone mass at the fracture end and loosening of the prosthesis.