Periprosthetic tibial fractures following total knee arthroplasty are rare but challenging complications, especially in patients who have undergone revision surgeries. The study conducted by Doorgakant, Bhutta, and Marynissen (2009) aimed to present the application and outcomes of using a pulsed electromagnetic field stimulation device (PEMFD) in managing a type IIA periprosthetic tibial fracture, representing the first documented case of therapeutic success with this intervention.
Intervention Used in the Study
The case involved a 75-year-old female patient with a history of advanced knee osteoarthritis and valgus deformity, who initially underwent a total knee arthroplasty. However, she developed medial collateral ligament failure, necessitating a revision surgery with a stemmed prosthesis.
Subsequently, the patient sustained a periprosthetic tibial fracture involving the metaphysis and fibula, with a gap exceeding 10 mm. Attempts at conservative treatment, such as manipulation under anesthesia and immobilization with a cast, proved ineffective.
Given this complex scenario, the use of a pulsed electromagnetic field stimulation device (Physio-stim, Intavent ORTHOFIX Ltd., UK) was chosen. The patient was instructed to use the PEMFD for at least 3 hours daily, continuing the protocol until bone consolidation was achieved.
Results Presented by the Study
The application of PEMFD yielded positive and progressive clinical outcomes:
- After 4 weeks of therapy, sufficient clinical stability was observed, allowing the long leg cast to be replaced with a hinged knee brace.
- The patient progressed to 50% partial weight-bearing and subsequently to full weight-bearing 4 months after the fracture.
- Complete bone consolidation, both clinically and radiographically, occurred 8 months after the fracture and 7 months after the initiation of PEMFD.
- At 21 months post-trauma and 14 months after bone consolidation, the patient remained asymptomatic and fully weight-bearing.
Authors’ Interpretation
The authors interpreted this case as promising initial evidence of the efficacy of PEMFD in the treatment of periprosthetic tibial fractures, emphasizing that this is the first successful report in this specific context.
Despite the inherent limitations of a single case study, the results suggest that pulsed electromagnetic field stimulation may broaden its therapeutic indications, particularly in complex cases or in frail patients for whom additional surgical interventions could pose elevated risks.
Although bone consolidation took one month longer than the timeframe estimated by the device manufacturer, the authors considered the outcome favorable, taking into account the complexity of the fracture pattern and the patient’s clinical condition.
Reference: Doorgakant A, Bhutta MA, Marynissen H. Management of a tibial periprosthetic fracture following revision knee arthroplasty using a pulsed electromagnetic field stimulation device: a case report. Cases J. 2009;2:8706. Published 2009 Aug 5. doi:10.4076/1757-1626-2-8706