An Early Periprosthetic Fracture of a Cementless Oxford Unicompartmental Knee Arthroplasty: Risk Factors and Mitigation Strategies

Introduction: The cementless Oxford partial knee arthroplasty is associated with low perioperative complications and good long-term survival rates. However, perioperative fractures remain a serious morbidity for patients. Case Report: This case report describes an early post-operative tibial periprosthetic fracture through the keel slot, which we believe may be contributed by the deep implant keel design and the presence of a narrow metaphysis in the Asian knee. The patient subsequently underwent a revision total knee replacement and fixation of the periprosthetic fracture. Conclusion: This paper discusses the ways to identify patients at high risk of developing periprosthetic fractures and to minimize such occurrences, including adopting a modified tibial preparation, doing precise saw cuts, and considering a cemented tibial implant. Keywords: Cementless, Oxford, unicompartmental, periprosthetic, keel.

Cost of Revision Total Knee Replacement: A Protocol For Systematic Review And Meta Analysis

Background A major limitation of Total Knee Replacement (TKR) as to other joint replacements is the risk is revision. Revision TKR is associated with high risk and economic burden to patients, healthcare provider and the society. It will be worthwhile to analyze how close or far the economic burden of revision TKR vary across countries or already existing studies. It is important to compare the studies characteristics and identify factors that are determinants of cost and outcome variability in the management in order to inform decisions for future revision TKR. This study aim to review the literature on the cost of revision TKR to assess cost variation across countries and studies; estimate a pooled cost estimate; identify factors that contribute the high cost and provide recommendation for cost minimization; identify limitation and gaps in cost burden assessment of existing studies and provide recommendations for future research.Methods We will search MEDLINE (OvidSp), Embase, Cochrane Library, EconLit, Google Scholar and Scopus to identify relevant studies. We will use an advanced search approach to search for relevant studies. EndNote library will be used to manage searched studies. Selection will done in two phase: screening and eligibility. Selection, data extraction assessment of risk of bias will be done in duplicates after which the data will be analysed descriptively and a meta-analysis performed.Discussion This protocol provides a proposed stepwise plan in conducting a systematic review and meta-analyses of cost of revision total knee replacement. Findings from this systematic review will provide information about factors associated with high costs of revision TKR, proffer recommendations to minimize cost and inform where future knee arthroplasty management decisions and future research should focus.Systematic Review Registration: PROSPERO CRD42020171988