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 proximity to the prosthesis. There were 61 Type I fractures, occurring at the tibial plateau; 22 Type II fractures, occurring adjacent to the prosthetic stem; 17 Type III fractures, occurring distal to the prosthetic stem; and two Type IV fractures, involving the tibial tubercle. Fracture types were additionally classified by whether the prosthesis appeared 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 IIB, and these were treated most successfully with revision surgery. Types IIA, IIIA, and IVA fractures were managed successfully by the usual principles of tibial fracture treatment. Type IC fractures usually were managed by intraoperative fixation, Type IIC by bone grafting or external immobilization and weightbearing restrictions, and Type IIIC by conventional fracture management. This classification system provides a guide for determining the appropriate treatment for tibial fractures associated with total knee arthroplasty.