Risk of periprosthetic fracture after anterior femoral notching: a 9-year follow-up of 200 total knee arthroplasties

Narendra Gujarathi, Amit B. Putti, Rami J. Abboud, James G. B. MacLean, Arthur J. Espley, Catherine F. Kellett

    Research output: Contribution to journalArticle

    40 Citations (Scopus)

    Abstract

    Background Notching of the anterior femoral cortex in distal femoral fractures following TKR has been observed clinically and studied biomechanically. It has been hypothesized that femoral notching weakens the cortex of the femur, which can predispose to femoral fractures in the early postoperative period. We examined the relationship between notching of the anterior femoral cortex during total knee replacement (TKR) and supracondylar fracture. Patients and methods Postoperative lateral radiographs of 200 TKRs were reviewed at an average of 9 (615) years postoperatively. 72 knees (41%) showed notching of the anterior femoral cortex. Notches were classified into 4 grades using the Tayside classification as follows. Grade I: violation of the outer table of the anterior femoral cortex; grade II: violation of the outer and the inner table of the anterior femoral cortex; grade III: violation up to 25% of the medullary canal (from the inner table to the center of the medullary canal); grade IV: violation up to 50% of the medullary canal (from the inner table to the center of the medullary canal) and unclassifiable. Results The interobserver variability of the classification system using Cohen's Kappa score was found to be substantially reliable. 3 of the 200 TKRs sustained later supracondylar fractures. One of these patients had grade II femoral notching and the other 2 showed no notching. The patient with femoral notching sustained a supracondylar fracture of the femur following a simple fall at home 9 years after TKR. Interpretation There is no relationship between minimal anterior femoral notching and supracondylar fracture of the femur in TKR.
    Original languageEnglish
    Pages (from-to)553-556
    Number of pages4
    JournalActa Orthopaedica
    Volume80
    Issue number5
    DOIs
    Publication statusPublished - Oct 2009

    Keywords

    • Adult
    • Aged
    • Article
    • Female
    • Femur
    • Follow up
    • Fracture
    • Human
    • Humerus supracondylar fracture
    • Knee radiography
    • Major clinical study
    • Male
    • Periprosthetic fracture
    • Reliability
    • Retrospective study
    • Risk assessment
    • Scoring system
    • Total knee replacement

    Fingerprint Dive into the research topics of 'Risk of periprosthetic fracture after anterior femoral notching: a 9-year follow-up of 200 total knee arthroplasties'. Together they form a unique fingerprint.

  • Cite this

    Gujarathi, N., Putti, A. B., Abboud, R. J., MacLean, J. G. B., Espley, A. J., & Kellett, C. F. (2009). Risk of periprosthetic fracture after anterior femoral notching: a 9-year follow-up of 200 total knee arthroplasties. Acta Orthopaedica, 80(5), 553-556. https://doi.org/10.3109/17453670903350099