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 Table of Contents    
LETTER TO EDITOR  
Year : 2015  |  Volume : 49  |  Issue : 6  |  Page : 680-681
Author's reply


Max Institute of Musculoskeletal Sciences, Max Healthcare, Saket, New Delhi, India

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Date of Web Publication3-Nov-2015
 

How to cite this article:
Thukral R, Marya S, Singh C. Author's reply. Indian J Orthop 2015;49:680-1

How to cite this URL:
Thukral R, Marya S, Singh C. Author's reply. Indian J Orthop [serial online] 2015 [cited 2019 Dec 14];49:680-1. Available from: http://www.ijoonline.com/text.asp?2015/49/6/680/168761
Sir,

In response to the reader's comments,[1] we would like to state that we initially had the same inference from the results of our study.[2] Removal of bone from the intercondylar notch area in posterior cruciate (PC)-substituting designs imparts vulnerability to the thinned out medial femoral condyle and may lead to intraoperative fractures [3] but this has not been reported anywhere to predict the risk of postoperative fractures.

On exhaustive literature search, we found no definite evidence reported by any study suggesting the higher risk of delayed periprosthetic fractures with PC-substituting designs (as has been alluded to by the readers). The associations studied (and reported) have been with female sex,[4] age [4],[5] (ages, 61–80 years had the highest risk), osteoporosis,[5] inflammatory arthritis,[5] corticosteroid use [5] and revision total knee arthroplasty (TKA) surgery,[4],[5] as has been highlighted in our report.[2]

Interestingly, higher comorbidity scores were found to predict a higher risk of periprosthetic fracture in both primary and revision TKA, with higher risks in patients suffering from peptic ulcer disease and pulmonary disease.[5]

We agree with the readers' alluded reference stating difficulties in fixation seen in locking plate fixation of very distally located periprosthetic fractures, and have recommended revision to a distal femoral replacement prostheses in these situations.[2]

 
   References Top

1.
Yadav A. Management of implant-stable distal femoral periprosthetic fractures by distal femoral locking plate: A retrospective study. Indian J Orthop 2015;49:680.  Back to cited text no. 1
  Medknow Journal  
2.
Thukral R, Marya SK, Singh C. Management of implant-stable distal femoral periprosthetic fractures by distal femoral locking plate: A retrospective study. Indian J Orthop 2015;49:199-207.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Alden KJ, Duncan WH, Trousdale RT, Pagnano MW, Haidukewych GJ. Intraoperative fracture during primary total knee arthroplasty. Clin Orthop Relat Res 2010;468:90-5.  Back to cited text no. 3
    
4.
Meek RM, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br 2011;93:96-101.  Back to cited text no. 4
    
5.
Singh JA, Jensen M, Lewallen D. Predictors of periprosthetic fracture after total knee replacement: An analysis of 21,723 cases. Acta Orthop 2013;84:170-7.  Back to cited text no. 5
    

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Correspondence Address:
Rajiv Thukral
Institute of Orthopedics and Joint Replacement, Max Super Specialty Hospital, 1, Press Enclave Road, Saket, New Delhi - 110 017, India.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.168761

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