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Can you injure a knee replacement? Fractures following knee replacement surgery are a rare complication that might require revision knee replacement. Periprosthetic knee fracture might occur because of a fall/trauma after the surgery or might occur without any history of trauma/fall due to a loose component or mal-aligned component.
Fractures not displaced around the prosthetic knee joint may be treated with nonsurgical treatment options. However, displaced fractures usually require surgical treatment.
A knee replacement surgery is performed after all nonsurgical treatment methods have been tried for knee arthritis. During surgery, they cut the diseased ends of the bones, creating the knee joint. The lower part of your thigh bone (or femur) is cut and then replaced with a femoral component. Likewise, the shin bone's upper part (tibia) is cut and replaced with a tibial component. The kneecap's undersurface is often resurfaced, and a plastic component is fixed.
The periprosthetic fracture following a knee replacement may occur during the surgery, immediately after, or days/weeks/years after. The fracture might occur in the femur, the tibia, or the patella. There might be certain risk factors associated with periprosthetic knee fracture, including:
The fracture of the inner side of the lower end of your femur (medial femoral condyle) happens mostly during the surgery. The management of femur periprosthetic fractures relies upon the fracture's location and the prosthesis's stability.
Nondisplaced stable periprosthetic fractures may be managed using nonoperative braces or casting methods. Fractures above the prosthesis using a stable prosthesis might be fixed with a nail or a metal plate that is fixed with screws.
A loose femoral component is revised using a femoral component with a long stem. In rare occurrences, an extensive fracture in older people might require the replacement of the entire lower end of your femur (distal femoral replacement).
Tibial fractures happen most commonly due to mal-aligned components or in patients with a history of tibial surgery. Nonsurgical treatment in the form of casting/bracing may be done for nondisplaced stable fractures. Unstable fractures with a stable prosthesis might be managed with cables, plates, wires, etc. Fractures with an unstable prosthesis are usually revised with a long-stem prosthesis.
Kneecap (patella) fractures are common, wherein the patella is resurfaced with a plastic prosthetic component. Fractures of the patella commonly occur due to intraoperative surgical methods. Damage to the patella's blood supply might lead to patellar bone death and subsequent fracture.
Irregular resurfacing of the patella, the residual patella's inappropriate thickness, and using single-peg implants have been associated with patellar periprosthetic fractures.
Patellar fractures that cause problems with the extensor mechanism (the ability to lift a straight leg) or using an unstable prosthesis are managed with surgical treatment. The surgical treatment might consist of removal of the patella, wire fixation, partial removal of the patella, revision of prosthesis, etc.
Stable fractures might be fixed with nonsurgical methods like casting/bracing. Patients with periprosthetic patella fractures might complain of only minor pain in front of their knee compared to femoral or tibial periprosthetic fractures where there's severe pain, prompting a visit to the ER.
Pain is the most common complication following a joint replacement. Knee replacement works for about 90% of people, bringing back knee function. Still, issues might arise post-surgery at times.
Other common signs of complications of knee surgery are the following:
Clicking, popping, and grinding sounds after surgery are common knee replacement side effects.
Clicking or tapping sounds usually begin several weeks following a knee replacement surgery as swelling reduces and the range of motion improves. At three months, noises may occur more frequently with increased physical activity.
It is normal for patients to experience some degree of pain up to half a year after surgery. Nevertheless, if pain persists six months after the procedure, it is generally considered long-term or chronic.
Several researchers have examined chronic pain frequency among patients with total knee replacement. Findings suggest that approximately 20 percent of patients report this complication.
TKA helps people with osteoarthritis by bringing back knee movement. Stiffness usually gets better around six weeks following the surgery. Around three months after the operation, patients are expected to recover approximately 90% of their knee motion.
A restricted range of motion might persist post-surgery if a person had knee stiffness before TKA and the surgeon couldn't address the anatomical issues causing stiffness. Moreover, lifestyle habits associated with stiffness might play a role in a limited range of motion after the procedure. Lastly, specific surgical errors during TKA can impede knee function and lead to postoperative knee stiffness.
Nerve damage can happen during surgery but usually disappears within six months. Nerve damage symptoms include a tingling sensation in the leg, radiating pain, and numbness in the foot or leg.
Surgeons must cut and stretch muscle and skin during surgery.
The American Academy of Orthopedic Surgeons says "stretching, pressure or cutting" can damage nerves around the joint or in the leg. Knee surgery might involve special tourniquets to limit blood flow in the leg. This restriction might put pressure on nerves, resulting in damage.
Fractures, infection, or implant failure are just three complications that might require a knee revision. A knee revision, otherwise called reoperation, is a surgery that involves replacing the prosthetic implants from the original surgery.
Those with knee replacement surgery might require another prosthetic knee over time. A knee revision might be necessary if knee implants fail because of loosening, wear, or other issues.
Complications that can result in a revision include:
While the chance of infection is low, it can be a damaging complication from knee replacement surgery. The plastic and metal implants might serve as a place for bacteria to grow, and their location might make them inaccessible to antibiotics. As a result, infections can damage bone or muscle, weakening the implant.
Infection usually requires surgery to remove the device and infected muscle or other tissue. Successful treatment relies on the bacteria, the infection duration, and the patient's health. In rare instances, infections might lead to amputation.
Loosening is among the most common complications of total knee replacement surgery requiring revision. There are many causes for loosening; infection is a probable cause. Aseptic loosening is an inflammatory response leading to bone loss and implant loosening when no infection occurs.
Younger age is linked with a higher risk of aseptic loosening. Other factors include age, sex, activity levels, BMI, consumption of alcohol and tobacco, and bone quality and geometry.
A total knee replacement (TKR) with instability happens when the supporting soft tissues cannot function or have failed because of the component size and position. It's a common reason for revision surgery, but specialists say that determining the causes of instability can make you able to restore balance and stability for a successful outcome.
Fractures following a TKR are a rare complication that might require revision knee replacement. Fractures to the femur, tibia, or patella might occur anytime, even years after surgery.
The risk factors of fracture include inflammatory conditions, age, and osteoporosis. Moreover, long-term steroid use and certain neurological diseases like Parkinson's or epilepsy increase risk.
Knee implant rejection is very rare. Implant rejection or metal hypersensitivity occurs once the metal in the implant activates a reaction in the patient's body. This problem can be an autoimmune response or an allergic reaction.
TKR often improves physical function and reduces pain, but pain is among the most common long-term complications of knee replacement surgery. Around 20 percent of patients report chronic postoperative knee pain. Researchers have associated this type of chronic pain with increased inflammation, decreased function, and higher levels of depression.
If you start to experience knee replacement problems ten years after surgery, you might be undergoing a loosening of the implant or some other complication. Make sure to follow up with your doctor for the care you need.
Modern medicine sees knee replacement surgeries as highly successful. Complications seldom occur, and patients typically express high satisfaction rates. Periprosthetic knee replacement fractures are infrequent due to advanced implants and techniques.
Surgeons' experience in knee surgeries is a vital factor that might determine the outcome of the surgery. Periprosthetic fractures often require operative treatment, and a surgeon well-trained in revision surgeries may offer the best management of the fractures.
If you need highly skilled and well-experienced surgeons to help restore your knees' function through TKR, you can be sure that you're in good hands with our doctors at Sunnyvale Sports Medicine and Orthopedic Center. Please reach out to us to schedule an appointment!