During revision total knee arthroplasty (TKA), the tibial stem cannot be extracted despite standard technique. The Vancouver classification is used for periprosthetic fractures around a TKA component. A fracture at the tip of a well-fixed tibial stem (stress riser) with minimal displacement in a 74-year-old is classified as:

• A Felix type IIIa — fracture at the stem tip, stable implant ✓
• B Vancouver type I — metaphyseal fracture, stable implant
• C Su type II — fracture of the distal femur above TKA
• D AO/OTA type B2 — fracture with loose stem requiring revision

Explanation

Periprosthetic fractures around TKA tibial components are classified by the Felix classification (not Vancouver, which is for periprosthetic hip fractures). Felix type IIIa describes a fracture at the tip of the tibial stem with a stable, well-fixed implant. Vancouver classification applies to periprosthetic femoral fractures around total hip arthroplasty (type A, B1, B2, B3, C). Su classification applies to distal femoral fractures above TKA. Felix type IIIa fractures with stable implants can often be managed conservatively or with ORIF without component revision.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.