title: Periprosthetic femoral condyle fracture after total knee arthroplasty and saline-coupled bipolar sealing technology.
abstract: Saline-cooled bipolar radiofrequency technology has emerged as an effective method to reduce bleeding during total knee arthroplasty (TKA). No significant osseous complications have been previously reported, and animal studies have revealed no difference in bone healing, strength, or osteonecrosis compared to conventional monopolar electrocautery. This article presents 4 cases of early postoperative periprosthetic femoral condyle fractures after extensive use of saline-cooled bipolar radiofrequency requiring revision TKA. Preoperative, intraoperative, and postoperative details from 4 patients who underwent early TKA revision for periprosthetic femoral condyle fractures were retrospectively reviewed. The senior author (M.M.) had not experienced similar condyle fractures postoperatively in over 2,500 primary TKAs performed over 2 decades. The cases described here were performed between July 2009 and November 2009, shortly after increasing the usage of saline-cooled bipolar radiofrequency on the synovium overlying the femoral condyles for hemostasis. No other change in surgical technique or implant that occurred during this time was observed. The senior author has significantly decreased his use of saline-cooled bipolar radiofrequency and has seen no recurrence of these complications.
authors.affiliation: The Ohio State University Medical Center, Department of Orthopedics, 4110 Cramblett Hall, 456 W10th Ave, Columbus, Ohio 43210, USA. Vincent.Ng@osumc.edu
authors.forename: Vincent Y
authors.initials: VY
authors.lastname: Ng
authors.forename: Lindsay
authors.initials: L
authors.lastname: Arnott
authors.forename: Michael
authors.initials: M
authors.lastname: McShane
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004564:Electrocoagulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000209:etiology*; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000209:etiology*; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D012086:Reoperation; D012965:Sodium Chloride / Q000627:therapeutic use; D000074402:Synovectomy
chemical_list: D012965:Sodium Chloride