Trans-tibial tension band wiring versus heavy suture fixation for type II periprosthetic patellar fractures after total knee arthroplasty: A comparative cohort study.

Abstract

Periprosthetic patellar fractures (PPPFs) following total knee arthroplasty (TKA) remain a challenging complication with high rates of fixation failure and functional impairment. Optimal surgical management for type II PPPF remains unclear. This study compared outcomes between transtibial tension band wiring (TTTBW) and heavy suture fixation (HSF). A retrospective review identified 18 patients with type II PPPF treated between 2020 and 2023 (HSF, n = 12; TTTBW, n = 6). Primary outcomes included implant survival and extensor mechanism function, assessed by extension lag, flexion arc, anterior knee pain, and a composite functional grading system. Mean follow up was 13.9 months. Implant survival was significantly higher in the TTTBW group (83%) than in the HSF group (8%) (P = 0.001). Mean extension lag was significantly lower in the TTTBW group (10 ± 24.5°) compared with the HSF group (32.5 ± 18.5°) (P = 0.044). Excellent functional outcomes were observed in 67% of TTTBW patients versus 8% in the HSF group. Implant prominence was more frequent with TTTBW (33%; P = 0.034). Although reoperation rates were comparable (HSF 5/12 vs TTTBW 2/6; P = 0.732), HSF failures were mainly due to persistent extensor mechanism insufficiency, whereas TTTBW reoperations were primarily implant related. TTTBW was associated with higher implant survival and improved functional outcomes compared with HSF in the management of type II PPPF, although a higher incidence of implant-related complications was observed. When performed with meticulous surgical technique, this approach may provide stable fixation while restoring extensor mechanism function.