Periprosthetic Tibial Plateau Fractures After Unicompartmental Knee Arthroplasty Are Successfully Treated With Open Reduction and Internal Fixation

Periprosthetic tibial fractures after unicompartmental knee arthroplasty (UKA) are rare but devastating events. Given the relative infrequency of these injuries, treatment strategies are not well defined. The goal of this retrospective case series is to report the findings for a series of patients who underwent open reduction and internal fixation (ORIF) of periprosthetic fracture after UKA, including radiographic alignment, Knee Society Score (KSS), and failure rate. Patients were identified by the International Classification of Diseases code for periprosthetic tibial plateau fractures. Electronic medical records and radiographs were retrospectively reviewed. Fracture patterns and coronal and sagittal alignment of UKA components were measured on radiographs. Clinical outcomes, including range of motion assessment, visual analog scale pain score, and KSS, were collected at final follow-up. Eight patients satisfied the inclusion criteria for this study. Fractures occurred at a median of 14 days (range, 5-52 days) after UKA, and all showed a vertical shear pattern that exited at the meta-diaphyseal junction. Of the 8 fractures, 7 (87.5%) healed to radiographic and clinical union after the initial ORIF. One patient required reoperation for hardware failure. Mean visual analog scale pain score and KSS at final follow-up were 3 and 85±14, respectively. Periprosthetic tibial plateau fractures after UKA commonly occur as a vertical shear fracture exiting at the metadiaphyseal junction. The use of ORIF with a 3.5-mm plate in buttress mode is a reliable method for treatment of these fractures. Restoration of alignment and motion is achievable, but residual pain may affect patient-reported outcome scores. [Orthopedics. 2022;45(5):287-292.].