Intraoperative Fracture During Aseptic Revision Total Knee Arthroplasty

Bone encountered during revision knee arthroplasty is compromised and predisposed to fracture. This study reports the rate, location, timing, treatment, and outcome of intraoperative fractures occurring during revision knee arthroplasty. Between 1997 and 2011, 2836 aseptic revisions were performed. Ninety-seven fractures were identified in 89 patients (3%). Fifty occurred in femora, 42 in tibiae, and 5 in patellae. Forty-six occurred during exposure, 21 during bony preparation, 17 during trialing, and 13 during final component placement. Treatment included fixation (n = 43), observation (n = 21), component build-up (n = 17), bone grafting (n = 6), and a combination (n = 3). Ninety-four percent of fractures united. Fifteen patients required a re-revision (17%), of which infection was the leading cause (n = 5).