Anterior femoral notching ≥ 3 mm is associated with increased risk for supracondylar periprosthetic femoral fracture after total knee arthroplasty: a systematic review and meta-analysis.
PURPOSE
Anterior femoral notching (AFN) may be associated with a higher risk for supracondylar periprosthetic fracture (sPPF) after total knee arthroplasty (TKA), although studies have yielded inconclusive results. We aimed to systematically investigate and meta-analyze the best available evidence regarding the association between AFN and the risk of sPPF after TKA.


METHODS
A comprehensive search of PubMed, Scopus, Mendeley, Google Scholar and Cochrane databases was performed, from conception to February 29, 2020. Data were expressed as odds ratio (OR) with 95% confidence intervals (CI). I2-index was employed for heterogeneity. Newcastle-Ottawa scale was implemented for quality assessment of the included studies.


RESULTS
Nine studies fulfilled the eligibility criteria, including a total of 3264 patients subjected to TKA. Among them, there were 150 patients who sustained a sPPF. Overall, patients exposed to AFN (AFN group) demonstrated an increased risk for sPPF compared to those not exposed (control group) (OR 3.91, 95% CI 1.22-12.58, p = 0.02; I2 68.52%). Subgroup analysis based on AFN depth with a cut-off value of 3 mm further clarified this association. Patients with AFN ≥ 3mm were at higher risk for sPPF compared to patients with AFN < 3 mm and control group (OR 4.85, 95% CI 2.08-11.33, p = 0.00; I2 0.0%). On the contrary, fracture risk was not significant for patients with AFN < 3 mm compared to the control group (OR 5.0, 95% CI 0.44-56.82, p = 0.19; I2 42.99%).


CONCLUSION
Patients, exposed to AFN ≥ 3 mm in depth, are at higher risk for sustaining a sPPF.
['Stamiris|Dimitrios|D|http://orcid.org/0000-0002-8558-1523', 'Gkekas|Nifon K|NK|', 'Asteriadis|Konstantinos|K|', 'Stamiris|Stavros|S|', 'Anagnostis|Panagiotis|P|', 'Poultsides|Lazaros|L|', 'Sarris|Ioannis|I|', 'Potoupnis|Michael|M|', 'Kenanidis|Eustathios|E|', 'Tsiridis|Eleftherios|E|']
Anterior femoral notching Total knee arthroplasty Systematic review Meta-analysis Supracondylar periprosthetic fracture