Periprosthetic tibial fracture after total knee arthroplasty with popliteal artery injury-A case report

Abstract

We present the case of a 79-year-old woman who presented at our center with a periprosthetic tibial fracture with a popliteal artery injury after total knee arthroplasty. Anastomosis of the popliteal artery was performed on the day of injury, and was later treated by open reduction and internal fixation. The patient was able to walk 3 months after injury. The present case was difficult to treat because of the arterial injury associated with periprosthetic fracture. Although revision of the implant was considered, open reduction and internal fixation was selected because of the severity of soft-tissue damage. The mechanism of injury is not uncommon, and it is expected that similar fractures will become more prevalent in the future as the number of knee replacement surgeries increases.

Keywords: Periprosthetic fracture after total knee arthroplasty (TKA); Popliteal artery injury.

Fig. 1

X-ray taken on the day of injury. These show a periprosthetic tibial fracture after total knee arthroscopy (TKA).

Fig. 2

Computed tomography angiogram showing popliteal artery injury. Popliteal artery blood flow is disrupted around the right knee.

Fig. 3

a. Photograph of the popliteal artery showing a semicircular partial rupture at the bifurcation of the anterior and the posterior tibial arteries. It is just behind the fracture. b. Photograph of the anastomosis made between the popliteal and posterior tibial arteries.

Fig. 4

X-ray image of the internal fixation that was performed after waiting for stabilization of the repaired blood vessels.

Fig. 5

X-ray image showing the screws that were inserted forwards and backwards of the keel of the tibial implant. We consider this to be superior in mechanical strength.

Fig. 6

X-ray taken 5 months after open reduction and internal fixation. Bone healing was confirmed.

Fig. 7

Schematic diagram of injury mechanism. a. Hyperextension causes a load on the front surface of the tibial component. b. The anterior portion of the tibial component sinks, and fracture occurs in front of the tibia. c. The tibial component tilts forward and the posterior tibia pushes out by the keel, injuring the popliteal artery.