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Intraoperative fractures rarely occur during initial total knee replacement surgery unless long-stem components are used. The incidence increases, however, during revision arthroplasty due to weakened bone and placement of longer-stem prostheses. They may occur during exposure, implant removal, bone preparation or placement of a prosthesis. Fractures occur most commonly in the femur, followed by the patella and tibia.
Portable AP knee radiograph obtained in recovery room status post total knee replacement surgery complicated by fracture of the medial femoral condyle (arrow).
Long-stemmed revision total knee replacement complicated by periprosthetic fracture (arrow).