This retrospective study of 1089 consecutive TKAs examined whether anterior femoral notching increases the risk of periprosthetic supracondylar femoral fracture. Radiographs were reviewed by blinded observers to quantify notch presence and depth, with clinical outcomes tracked at mean 5.1-year follow-up. The study tests a widely held surgical concern against a large real-world dataset.
Femoral notching has long been taught as a predisposing risk factor for periprosthetic supracondylar fracture — a teaching reinforced by cadaveric data showing reduced torsional and bending strength. This paper challenges that dogma directly.
In 1089 consecutive TKAs followed for over 5 years, not a single fracture occurred through a notched femur. When you are intraoperatively deciding between notching the anterior cortex or upsizing the component, this paper supports notching as the safer choice for gap balance.
With posterior referencing instruments, notching preserves the flexion-extension gap; flexing the component to avoid notching risks imbalancing the knee. A trade-off with clearer functional consequences than fracture risk.
The 3.3-year mean time to fracture in this and prior series suggests that living bone remodels and redistributes stress, rendering the acute cortical defect clinically benign over time.
This retrospective study of 1089 consecutive TKAs examined whether anterior femoral notching increases the risk of periprosthetic supracondylar femoral fracture. Radiographs were reviewed by blinded observers to quantify notch presence and depth, with clinical outcomes tracked at mean 5.1-year follow-up. The study tests a widely held surgical concern against a large real-world dataset.
Femoral notching has long been taught as a predisposing risk factor for periprosthetic supracondylar fracture — a teaching reinforced by cadaveric data showing reduced torsional and bending strength. This paper challenges that dogma directly.
In 1089 consecutive TKAs followed for over 5 years, not a single fracture occurred through a notched femur. When you are intraoperatively deciding between notching the anterior cortex or upsizing the component, this paper supports notching as the safer choice for gap balance.
With posterior referencing instruments, notching preserves the flexion-extension gap; flexing the component to avoid notching risks imbalancing the knee. A trade-off with clearer functional consequences than fracture risk.
The 3.3-year mean time to fracture in this and prior series suggests that living bone remodels and redistributes stress, rendering the acute cortical defect clinically benign over time.