Reoperations After Operatively and Non-Operatively Treated Periprosthetic Knee Fractures: A Nationwide Study on 1,931 Fractures After Primary Total Knee Arthroplasty

S K Risager; K B Arndt; C Abrahamsen; B Viberg; A Odgaard; M Lindberg-Larsen

doi:10.1016/j.arth.2024.11.010

Reoperations After Operatively and Non-Operatively Treated Periprosthetic Knee Fractures: A Nationwide Study on 1,931 Fractures After Primary Total Knee Arthroplasty

S K Risager^*, K B Arndt, C Abrahamsen, B Viberg, A Odgaard, M Lindberg-Larsen

^*Corresponding author for this work

Department of Orthopaedics Surgery

7 Citations (Scopus)

Abstract

BACKGROUND: Periprosthetic knee fracture (PPKF) following total knee arthroplasty (TKA) can be difficult to treat. A PPKF can be treated both operatively and nonoperatively, and the treatment varies between fracture sites. This study aimed to assess the risk of reoperation according to the fracture site and treatment of the PPKF.

METHOD: This study is a nationwide cohort study using register data from 1997 to 2022. Cruciate-retaining or posterior-stabilized primary TKA were identified from the Danish Knee Arthroplasty Register. Subsequent PPKFs, fracture treatments, and later reoperations were identified through the International Classification of Diseases, tenth edition (ICD-10) diagnosis and procedure codes in the Danish National Patient Register. In addition, indications for revision total knee arthroplasty (rTKA) in the Danish Knee Arthroplasty Register were used to identify PPKFs and the reason for reoperation.

RESULTS: We included 1,931 PPKFs (1,494 femoral, 207 patellae, and 230 tibial) with an overall two-year reoperation risk of 20% (95% confidence interval (CI): 18 to 23). Femoral PPKFs had a two-year reoperation risk of 16% (CI: 12 to 22) after nonoperative treatment and 21% (CI: 18 to 24) after operative treatment. Patellar PPKFs had a two-year reoperation risk in five to 17 after nonoperative treatment and 46% (CI: 30 to 69) after operative treatment. Tibial PPKFs had a two-year reoperation risk of 17% (CI: 11 to 27) after nonoperative treatment and 36% (25 to 53) after operative treatment.

CONCLUSIONS: The overall two-year reoperation risk was 20% (CI: 18 to 23). Operative-treated PPKFs had a higher risk of reoperation across all fracture locations. The highest reoperation risk was found after operatively treated patella and tibial PPKFs (46 and 36%, respectively), and the lowest reoperation risk was found after nonoperative-treated patella PPKFs.

Original language	English
Journal	The Journal of arthroplasty
Volume	40
Issue number	6
Pages (from-to)	1622-1628
Number of pages	7
ISSN	0883-5403
DOIs	https://doi.org/10.1016/j.arth.2024.11.010
Publication status	Published - Jun 2025

Keywords

operative versus nonoperative treatment
periprosthetic knee fracture
reoperation
total knee arthroplasty
type of reoperation
Arthroplasty, Replacement, Knee/adverse effects
Humans
Middle Aged
Male
Periprosthetic Fractures/therapy
Reoperation/statistics & numerical data
Denmark/epidemiology
Knee Fractures
Aged, 80 and over
Female
Registries
Aged
Tibial Fractures/therapy
Cohort Studies

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10.1016/j.arth.2024.11.010

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Reoperations After Operatively and Non-Operatively Treated Periprosthetic Knee Fractures: A Nationwide Study on 1,931 Fractures After Primary Total Knee Arthroplasty. / Risager, S K; Arndt, K B; Abrahamsen, C et al.
In: The Journal of arthroplasty, Vol. 40, No. 6, 06.2025, p. 1622-1628.

Research output: Contribution to journal › Journal article › Research › peer-review

@article{62954e1ab7f543149f7bba796439067a,

title = "Reoperations After Operatively and Non-Operatively Treated Periprosthetic Knee Fractures: A Nationwide Study on 1,931 Fractures After Primary Total Knee Arthroplasty",

abstract = "BACKGROUND: Periprosthetic knee fracture (PPKF) following total knee arthroplasty (TKA) can be difficult to treat. A PPKF can be treated both operatively and nonoperatively, and the treatment varies between fracture sites. This study aimed to assess the risk of reoperation according to the fracture site and treatment of the PPKF.METHOD: This study is a nationwide cohort study using register data from 1997 to 2022. Cruciate-retaining or posterior-stabilized primary TKA were identified from the Danish Knee Arthroplasty Register. Subsequent PPKFs, fracture treatments, and later reoperations were identified through the International Classification of Diseases, tenth edition (ICD-10) diagnosis and procedure codes in the Danish National Patient Register. In addition, indications for revision total knee arthroplasty (rTKA) in the Danish Knee Arthroplasty Register were used to identify PPKFs and the reason for reoperation.RESULTS: We included 1,931 PPKFs (1,494 femoral, 207 patellae, and 230 tibial) with an overall two-year reoperation risk of 20\% (95\% confidence interval (CI): 18 to 23). Femoral PPKFs had a two-year reoperation risk of 16\% (CI: 12 to 22) after nonoperative treatment and 21\% (CI: 18 to 24) after operative treatment. Patellar PPKFs had a two-year reoperation risk in five to 17 after nonoperative treatment and 46\% (CI: 30 to 69) after operative treatment. Tibial PPKFs had a two-year reoperation risk of 17\% (CI: 11 to 27) after nonoperative treatment and 36\% (25 to 53) after operative treatment.CONCLUSIONS: The overall two-year reoperation risk was 20\% (CI: 18 to 23). Operative-treated PPKFs had a higher risk of reoperation across all fracture locations. The highest reoperation risk was found after operatively treated patella and tibial PPKFs (46 and 36\%, respectively), and the lowest reoperation risk was found after nonoperative-treated patella PPKFs.",

keywords = "operative versus nonoperative treatment, periprosthetic knee fracture, reoperation, total knee arthroplasty, type of reoperation, Arthroplasty, Replacement, Knee/adverse effects, Humans, Middle Aged, Male, Periprosthetic Fractures/therapy, Reoperation/statistics \& numerical data, Denmark/epidemiology, Knee Fractures, Aged, 80 and over, Female, Registries, Aged, Tibial Fractures/therapy, Cohort Studies",

author = "Risager, \{S K\} and Arndt, \{K B\} and C Abrahamsen and B Viberg and A Odgaard and M Lindberg-Larsen",

year = "2025",

month = jun,

doi = "10.1016/j.arth.2024.11.010",

language = "English",

volume = "40",

pages = "1622--1628",

journal = "The Journal of arthroplasty",

issn = "0883-5403",

publisher = "Elsevier BV",

number = "6",

}

TY - JOUR

T1 - Reoperations After Operatively and Non-Operatively Treated Periprosthetic Knee Fractures

T2 - A Nationwide Study on 1,931 Fractures After Primary Total Knee Arthroplasty

AU - Risager, S K

AU - Arndt, K B

AU - Abrahamsen, C

AU - Viberg, B

AU - Odgaard, A

AU - Lindberg-Larsen, M

PY - 2025/6

Y1 - 2025/6

N2 - BACKGROUND: Periprosthetic knee fracture (PPKF) following total knee arthroplasty (TKA) can be difficult to treat. A PPKF can be treated both operatively and nonoperatively, and the treatment varies between fracture sites. This study aimed to assess the risk of reoperation according to the fracture site and treatment of the PPKF.METHOD: This study is a nationwide cohort study using register data from 1997 to 2022. Cruciate-retaining or posterior-stabilized primary TKA were identified from the Danish Knee Arthroplasty Register. Subsequent PPKFs, fracture treatments, and later reoperations were identified through the International Classification of Diseases, tenth edition (ICD-10) diagnosis and procedure codes in the Danish National Patient Register. In addition, indications for revision total knee arthroplasty (rTKA) in the Danish Knee Arthroplasty Register were used to identify PPKFs and the reason for reoperation.RESULTS: We included 1,931 PPKFs (1,494 femoral, 207 patellae, and 230 tibial) with an overall two-year reoperation risk of 20% (95% confidence interval (CI): 18 to 23). Femoral PPKFs had a two-year reoperation risk of 16% (CI: 12 to 22) after nonoperative treatment and 21% (CI: 18 to 24) after operative treatment. Patellar PPKFs had a two-year reoperation risk in five to 17 after nonoperative treatment and 46% (CI: 30 to 69) after operative treatment. Tibial PPKFs had a two-year reoperation risk of 17% (CI: 11 to 27) after nonoperative treatment and 36% (25 to 53) after operative treatment.CONCLUSIONS: The overall two-year reoperation risk was 20% (CI: 18 to 23). Operative-treated PPKFs had a higher risk of reoperation across all fracture locations. The highest reoperation risk was found after operatively treated patella and tibial PPKFs (46 and 36%, respectively), and the lowest reoperation risk was found after nonoperative-treated patella PPKFs.

AB - BACKGROUND: Periprosthetic knee fracture (PPKF) following total knee arthroplasty (TKA) can be difficult to treat. A PPKF can be treated both operatively and nonoperatively, and the treatment varies between fracture sites. This study aimed to assess the risk of reoperation according to the fracture site and treatment of the PPKF.METHOD: This study is a nationwide cohort study using register data from 1997 to 2022. Cruciate-retaining or posterior-stabilized primary TKA were identified from the Danish Knee Arthroplasty Register. Subsequent PPKFs, fracture treatments, and later reoperations were identified through the International Classification of Diseases, tenth edition (ICD-10) diagnosis and procedure codes in the Danish National Patient Register. In addition, indications for revision total knee arthroplasty (rTKA) in the Danish Knee Arthroplasty Register were used to identify PPKFs and the reason for reoperation.RESULTS: We included 1,931 PPKFs (1,494 femoral, 207 patellae, and 230 tibial) with an overall two-year reoperation risk of 20% (95% confidence interval (CI): 18 to 23). Femoral PPKFs had a two-year reoperation risk of 16% (CI: 12 to 22) after nonoperative treatment and 21% (CI: 18 to 24) after operative treatment. Patellar PPKFs had a two-year reoperation risk in five to 17 after nonoperative treatment and 46% (CI: 30 to 69) after operative treatment. Tibial PPKFs had a two-year reoperation risk of 17% (CI: 11 to 27) after nonoperative treatment and 36% (25 to 53) after operative treatment.CONCLUSIONS: The overall two-year reoperation risk was 20% (CI: 18 to 23). Operative-treated PPKFs had a higher risk of reoperation across all fracture locations. The highest reoperation risk was found after operatively treated patella and tibial PPKFs (46 and 36%, respectively), and the lowest reoperation risk was found after nonoperative-treated patella PPKFs.

KW - operative versus nonoperative treatment

KW - periprosthetic knee fracture

KW - reoperation

KW - total knee arthroplasty

KW - type of reoperation

KW - Arthroplasty, Replacement, Knee/adverse effects

KW - Humans

KW - Middle Aged

KW - Male

KW - Periprosthetic Fractures/therapy

KW - Reoperation/statistics & numerical data

KW - Denmark/epidemiology

KW - Knee Fractures

KW - Aged, 80 and over

KW - Female

KW - Registries

KW - Aged

KW - Tibial Fractures/therapy

KW - Cohort Studies

UR - https://www.scopus.com/pages/publications/85210640990

U2 - 10.1016/j.arth.2024.11.010

DO - 10.1016/j.arth.2024.11.010

M3 - Journal article

C2 - 39549884

SN - 0883-5403

VL - 40

SP - 1622

EP - 1628

JO - The Journal of arthroplasty

JF - The Journal of arthroplasty

IS - 6

ER -

Reoperations After Operatively and Non-Operatively Treated Periprosthetic Knee Fractures: A Nationwide Study on 1,931 Fractures After Primary Total Knee Arthroplasty

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Keywords

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