Arthroscopic Retrograde Intramedullary Nailing of Periprosthetic Fractures After Total Knee Arthroplasty-Technique, Safety, and Outcomes

Arthroplast Today. 2022 Aug 15;17:47-52. doi: 10.1016/j.artd.2022.07.003. eCollection 2022 Oct.


Background: Periprosthetic fractures after total knee arthroplasty are notoriously challenging entities to manage. The 2 major fixation techniques utilized include locking compression plates and retrograde intramedullary nailing. The challenges in obtaining correct entry points in the presence of the superimposing femoral component in retrograde intramedullary nailing often warrants a full knee joint arthrotomy. Thus, the purpose of this first series is to describe the arthroscopy-assisted retrograde intramedullary nailing (ARIN) technique and evaluate clinical results and potential risks and benefits.

Methods: This was a retrospective review of prospectively collected data obtained from 16 patients treated with the ARIN technique. Data obtained included operative time, size of incision, and intraoperative complications. In the postoperative course, patients were assessed for time to union, functional outcomes using the Knee Society Score, and the presence of complications.

Results: Nine male and 7 female patients were included with a mean age of 70.8 years. The patients were followed up for a minimum of 24 months. The mean operative time was 86.5 minutes. Union was achieved in all fractures with an average union time of 15.9 weeks. The mean Knee Society Score obtained at 2 years postoperatively was 84.6. No major complications were documented during the follow-up period. None of the cases required conversion to the conventional open technique.

Conclusions: The ARIN technique has demonstrated results comparable with those from previous resources. Although results from this series suggest that the utilized technique is safe and offers a less invasive approach, direct clinical comparisons in larger scale trials are required.

Keywords: Arthroscopic-assisted retrograde nailing; Arthroscopy; Periprosthetic fractures; Retrograde intramedullary nailing; Total knee arthroplasty.