Periprosthetic Fractures of the Knee Above Total Knee Joint Arthroplasty

Periprosthetic fractures of the distal femur above total knee arthroplasty are uncommon and their prevalence is between 0.3%-2.5%. These fractures present a challenging surgical problem and the ideal treatment is still controversial. During the last few years the incidence of such fractures has increased concomitantly due to both the growing number of knee joint replacements and the increasing life span of the patients. Rorabeck’s classification is the most commonly used for these fractures. It is based on the location and degree of displacement of the fracture and the stability of the prosthesis as follow: Type I - the fracture is undisplaced and the prosthesis is stable; Type II - the fracture is displaced and the prosthesis is stable; Type III - the fracture is either displaced or undisplaced but the prosthesis is loose and unstable. Treatment consists of stable fixation of the Type I or II fractures by either Locking Compression Plates (LCP) or the Less Invasive Stabilization System (LISS) plates or by a retrograde intramedullary nail and in Type III by revison total knee arthroplasty with the use of bone grafts and augments combined with reduction and stable fixation of the fracture. We present the various pathologies and treatment modalities for management of such periprosthetic femoral fractures above total knee arthroplasty.