Risk Factors Influencing Management Outcomes of Periprosthetic Fractures Following Total Knee Arthroplasty: A Retrospective Study

Abstract Background : Total knee replacement (TKR) is a widely performed surgery for advanced knee joint issues. The rising demand for TKR has led to an increase in periprosthetic fractures (PPFs), influenced by patient factors, surgical variables, and injury mechanisms. Understanding these factors is crucial for prevention and improvement of surgical methods and patient outcomes. Materials and methods : This retrospective cohort study evaluated knee periprosthetic fractures in patients from January 2019 to July 2025 at a tertiary center. Data was sourced from the arthroplasty unit database, encompassing various radiographs. Exclusion criteria included infections, mid shaft femur fractures, tibia periprosthetic fractures, road traffic accidents, and incomplete records. Data analysis utilized Microsoft Excel and SPSS for statistical assessments, verifying data quality with frequency tables and box plots. Comparisons included gender, obesity status, and independent risk factors, with statistical significance defined as a P value < 0.05. Results : A study of 2113 total knee replacement patients (mostly women, mean age 64) found a 0.47% incidence of periprosthetic fractures (PPFs), associated with bone fragility, obesity, and diabetes, particularly in older females and osteoporotic males. Among 10 patients with chronic conditions, treatment depended on fracture type, prosthesis stability, and bone quality: 4 underwent distal femur replacement, 5 received locking plate fixation, and 1 was managed conservatively. Late fractures (>5 years) were linked to osteoporosis and minor trauma, while early fractures (<3 months) stemmed from falls during rehabilitation, highlighting the importance of fall prevention strategies. Conclusion: An analysis of ten periprosthetic fracture cases after total knee replacement found a higher incidence in elderly, osteoporotic, and obese female patients, with osteoporosis and obesity as key risk factors. Management was challenging, and 70% required distal femoral replacement. The study emphasizes preventive measures such as weight control, patient education, and prophylactic femoral stems to reduce fracture risk and improve postoperative outcomes