Pre-existing knee arthroplasty dysfunction
1. Introduction
Many patients with periprosthetic fracture around a knee replacement report that they were unhappy with how the knee replacement was functioning before the injury. This knee arthroplasty dysfunction requires careful evaluation.
2. Evaluation
Potential causes of knee arthroplasty dysfunction include:
- Malpositioned component
- Incorrect implant size
- Aseptic loosening
- Prosthetic joint infection
- Septic loosening
- Osteolysis
- Stress fracture
Information regarding postoperative assessments and follow-up with the original arthroplasty surgeon is valuable. Old x-rays showing the status of the prosthesis over time are useful, but not always available. A new workup and diagnostic imaging are always required.
3. Treatment
If the cause for the pre-fracture joint symptoms is prosthesis related, revision arthroplasty instead of periprosthetic fracture fixation may be preferred. Alternatively, some fractures occurring in the presence of osteolysis and loose implants can be treated with fixation and then subsequent revision arthroplasty once fracture healing has been achieved. Consultation with a respected arthroplasty colleague is typically very helpful to design the best treatment path.
