Subtrochanteric fracture of the femur following knee replacement surgery: A case series and review of the literature

Abstract

Introduction and importance

Knee arthroplasties as an effective intervention is primarily performed in patients with primary osteoarthritis and rheumatoid arthritis. Risk of hip fracture may be either decreased or increased in patients with Knee arthroplasties. There is conflicting evidence in this regard. Over the years, some studies have reported the occurrence of hip fractures following this operation as a rare but severe complication. The aim of the present case series was to report diagnosis and treatment of the mentioned five cases.

Case presentation

During a period of two years, five patients with a diagnosis of a subtrochanteric fracture and history of total knee arthroplasty who referred to hospital were selected to include in the present case series.

Clinical discussion

the presence of RA and treatment with glucocorticoids, a reduction of BMD following knee replacement surgery, and ultimately, an increase in physical activity and movement after the arthroplasty due to the improvement of preoperational pain, may all contribute in a complex manner to the observed outcome of increased fracture risk in the hip following TKA.

Conclusion

In summary, special care including using medications to improve BMD should be taken to minimize the risk of such an event.

Highlights

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  Knee arthroplasties as an effective intervention is performed in patients with primary osteoarthritis and rheumatoid arthritis

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  Risk of hip fracture may be either decreased or increased in patients with Knee arthroplasties

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  The presence of RA and treatment with glucocorticoids, a reduction of BMD following knee replacement surgery, and an increase in physical activity and movement after the arthroplasty due to the improvement of preoperational pain, may all contribute in a complex manner to the observed outcome of increased fracture risk in the hip following TKA

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  Using medications including alendronate to improve BMD, treatment of patients with RA with medications other than glucocorticoids, and application of some new types of knee prosthesis to attenuate decreasing BMD are among the most important strategies for reducing the risk of subtrochanteric fracture of the femur