Periprosthetic medial tibial plateau fracture in robotic-assisted unicompartmental knee arthroplasty using a burr-all technique: A case report and literature review

Unicompartmental knee arthroplasty (UKA) has emerged as a popular treatment for isolated osteoarthritis affecting one knee compartment. Robotic assistance and use of burr-all techniques have been shown to aid with component placement and enhance precision and limb alignment. In this study, we report a medial vertical shear periprosthetic tibial plateau fracture after an uneventful robotic-assisted UKA using a burr-all technique presented 3 weeks postoperative. An analysis of the available literature was performed to investigate possible risk factors for periprosthetic fractures after UKA. After confirming good implant fixation to the fragment, the patient underwent open reduction with internal fixation (ORIF). At six weeks, postoperative X-rays revealed adequate consolidation and correct alignment of the fracture. The patient was pain-free at four months follow-up. Periprosthetic risk factors post-UKA were found to be similar to those identified for TKAs, special considerations for depth of resection into the proximal medial tibia, pin placement into the medial edge of the tibial plateau, and positioning of sagittal saw cuts. Meticulous care should be exercised during the preparation of the tibial plateau for a burr-all robotic assisted burr-all UKA to maintain stability. When loosening is ruled out, an ORIF with a plate in a buttress mode can be a feasible approach to treat a vertical shear periprosthetic tibial plateau fracture.