Fix or Replace? Comparable Outcomes With Internal Fixation and Distal Femoral Replacement for Periprosthetic Fractures Above Total Knee Arthroplasty

• Published in: The Journal of arthroplasty 2024-10
• Main Authors: Lizcano, Juan D., Giakas, Alec M., Goh, Graham S., Abbaszadeh, Ahmad, Reddy, Yashas C., Courtney, Paul M.
• Format: Article
• Language: English
• Subjects: distal femoral replacement; distal femur; internal fixation; osteosynthesis; periprosthetic fracture; revision TKA
• ISSN: 0883-5403; 1532-8406; 1532-8406
• DOI: 10.1016/j.arth.2024.10.006

The optimal treatment for periprosthetic fracture (PPfx) around total knee arthroplasty (TKA) remains a topic of debate. Due to its low incidence, comparative studies analyzing arthroplasty and fixation are lacking in the literature. The purpose of this study was to compare the outcomes of distal femoral replacement (DFR) and open reduction and internal fixation open reduction internal fixation (ORIF) for distal femur PPfx. We reviewed a consecutive series of 99 patients who underwent DFR (n = 54) or ORIF (n = 45) for distal femur PPfx. The indications for DFR were reviewed. Fractures were classified based on their relation to the implant using the Su classification. The primary outcome was rerevision, while secondary endpoints included inpatient complications, mortality within the first year, and mechanical complications such as loosening and non-union. Type 2 fractures were the most prevalent type in both groups (DFR 37 versus ORIF 48.9%), while Type 1 fractures were more commonly treated with ORIF (35.6 versus 16.7%) and Type 3 with DFR (46.3 versus 15.6%) (P = 0.003). The preferred techniques in the ORIF group were plate osteosynthesis (66.7%) and retrograde nailing (31.1%). At a mean follow-up of 4.2 years (range, one to 14.1), DFR and ORIF did not demonstrate any difference in revision rates (13 versus 24.4%, P = 0.140) or mortality (3.7 versus 4.4%, P = 0.887). However, more mechanical complications were noted in the ORIF group (22.2 versus 7.4%, P = 0.035). Both DFR and open reduction and internal fixation have comparable revision rates, complications, and clinical outcomes when used in supracondylar periprosthetic distal femur fractures. Longer-term studies are needed to assess DFR survivorship as well as outcomes of newer trauma techniques such as nail-plate combinations.