PERIPROSTHETIC FRACTURES OF THE TIBIA ASSOCIATED WITH TOTAL KNEE ARTHROPLASTY

One hundred two periprosthetic tibial fractures associated with total knee arthroplasty were identified in 29 men and 73 women, Eighty-three fractures occurred postoperatively, and 19 occurred intraoperatively, Fractures were classified into four types based on location and proxi mity to the prosthesis, There were 61 Type I fractures, occurring at t he tibial plateau; 22 Type II fractures, occurring adjacent to the pro sthetic stem; 17 Type III fractures, occurring distal to the prostheti c stem; and two Type IV fractures, involving the tibial tubercle, Frac ture types were additionally classified by whether the prosthesis appe ared to be radiographically well fixed (A) or loose (B) at the time of fracture, or whether the fracture occurred intraoperatively (C), The majority of postoperative Types I and II fractures were Types IB and I IB, and these were treated most successfully with revision surgery, Ty pes IIA, IIIA, and IVA fractures were managed successfully by the usua l principles of tibial fracture treatment, Type IC fractures usually w ere managed by intraoperative fixation, Type IIC by bone grafting or e xternal immobilization and weightbearing restrictions, and Type IIIC b y conventional fracture management, This classification system provide s a guide for determining the appropriate treatment for tibial fractur es associated with total knee arthroplasty.