Primary Versus Secondary Distal Femoral Arthroplasty for Treatment of Total Knee Arthroplasty Periprosthetic Femur Fractures

Abstract Current methods of fixing periprosthetic fractures after total knee arthroplasty (TKA) are variable, and include open reduction and internal fixation (ORIF) via plating, retrograde nailing, or revision using standard revision TKA components or a distal femoral arthroplasty (DFA). The purpos...

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Bibliographic Details
Published in:The Journal of arthroplasty 2013-10, Vol.28 (9), p.1580-1584
Main Authors: Chen, Antonia F., MD/MBA, Choi, Lisa E., MD, Colman, Matthew W., MD, Goodman, Mark A., MD, Crossett, Lawrence S., MD, Tarkin, Ivan S., MD, McGough, Richard L., MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee - adverse effects
Bone Plates
distal femoral arthroplasty
failure
Female
Femoral Fractures - etiology
Femoral Fractures - surgery
Femur - injuries
Femur - surgery
femur fractures
Fracture Fixation, Internal
Humans
Male
Middle Aged
open reduction and internal fixation
Orthopedics
periprosthetic fractures
Periprosthetic Fractures - etiology
Periprosthetic Fractures - surgery
Reoperation
Retrospective Studies
total knee arthroplasty
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Summary:Abstract Current methods of fixing periprosthetic fractures after total knee arthroplasty (TKA) are variable, and include open reduction and internal fixation (ORIF) via plating, retrograde nailing, or revision using standard revision TKA components or a distal femoral arthroplasty (DFA). The purpose of this study is to compare patients who failed plating techniques requiring subsequent revision to DFA to patients who underwent primary DFA. Of the 13 patients (9.2%) who failed primary ORIF, causes included nonunion (53.8%), infection (30.8%), loosening (7.7%), and refracture (7.7%). There were significantly more surgical procedures for ORIF revision to DFA compared to primary DFA. Complications for patients who underwent primary reconstruction with DFAs included extensor mechanism disruption (8.3%), infection (5.6%), and dislocation (2.8%). Primary reconstruction via ORIF is beneficial for preserving bone stock, but primary DFA may be preferred in osteopenic patients, or those at high risk for nonunion.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2013.02.030