This retrospective study asked whether notching the anterior femoral cortex during TKR raises the risk of later supracondylar fracture. 200 TKRs were followed for a mean of 9 years, and notches were graded using the Tayside classification. No significant association was found between notching and fracture.
Anterior femoral notching during TKR is common — 41% in this series — yet the feared consequence of supracondylar fracture was rare and not statistically linked to notching at 9-year follow-up.
This matters clinically because notching is often discussed as a technical error requiring urgent intervention, but the evidence here suggests that minimal notching (Grades I–II) is not an independent fracture risk factor. The Tayside classification gives you a structured way to document and communicate notch severity on the lateral radiograph.
When a periprosthetic supracondylar fracture does occur after TKR, rheumatoid arthritis, osteoporosis, and neurological disorders are the risk factors with stronger clinical evidence. If you see a fracture in a non-notched femur, look hard at the patient's bone quality and comorbidities.
The authors caution that they lacked numbers to assess Grade III and IV notching — so while minimal notching appears benign, deep medullary encroachment remains an open question. The early postoperative window (0–6 months) may still carry elevated risk before remodeling occurs.
This retrospective study asked whether notching the anterior femoral cortex during TKR raises the risk of later supracondylar fracture. 200 TKRs were followed for a mean of 9 years, and notches were graded using the Tayside classification. No significant association was found between notching and fracture.
Anterior femoral notching during TKR is common — 41% in this series — yet the feared consequence of supracondylar fracture was rare and not statistically linked to notching at 9-year follow-up.
This matters clinically because notching is often discussed as a technical error requiring urgent intervention, but the evidence here suggests that minimal notching (Grades I–II) is not an independent fracture risk factor. The Tayside classification gives you a structured way to document and communicate notch severity on the lateral radiograph.
When a periprosthetic supracondylar fracture does occur after TKR, rheumatoid arthritis, osteoporosis, and neurological disorders are the risk factors with stronger clinical evidence. If you see a fracture in a non-notched femur, look hard at the patient's bone quality and comorbidities.
The authors caution that they lacked numbers to assess Grade III and IV notching — so while minimal notching appears benign, deep medullary encroachment remains an open question. The early postoperative window (0–6 months) may still carry elevated risk before remodeling occurs.