Sir,We read with interest the article by Thukral et al. “Management of distal femoral periprosthetic fractures.”1We found a large number of posterior cruciate (PC) substitution total knee arthroplasty (TKA) (25 of 31) with fractures across their data intriguing. The lack of sizing data seems to suggest that PC substitution TKA, is a risk factor for fracture. It has been a question of considerable speculation that removal of bone from the intercondylar notch of the femur during TKA may impact vulnerability to subsequent periprosthetic fracture. The volume of the bone removed in the “box cut” varies – across manufacturers. Specifically, are the smaller sizes of prosthetic femurs more predisposed to such a fracture? Sizing data analysis could also influence treatment decision-making. If smaller sized knees with poorer residual bone stock after fracture2 were prone to adverse outcomes, they could be selected for a different mode of surgical care such as lower femoral prosthetic replacement instead of internal fixation.
Authors: Nabil A Ebraheim; Jiayong Liu; Sohaib Z Hashmi; Kyle R Sochacki; Muhammad Z Moral; Adam G Hirschfeld Journal: J Arthroplasty Date: 2011-10-02 Impact factor: 4.757