Functional outcomes of periprosthetic and non-periprosthetic distal femur fractures: a comparative study
Abstract
Aim: The purpose of this study was to compare the outcomes of locked plating in closed distal femur periprosthetic, and non-periprosthetic fractures. We hypothesized that the outcomes would be superior in the non-periprosthetic distal femur fracture group.
Material and Method: Patients who underwent surgery for distal femur fractures between January 2019 and January 2022 were retrospectively reviewed. Patients aged under 18 years, who had multiple fractures, pathological fractures, follow-up less than 6 months, previous history of revision knee arthroplasty, interprosthetic fractures between hip and knee arthroplasties, fixation performed other than distal locking femoral plate and intra-operative periprosthetic fractures were excluded. Patients’ age, gender, laterality, length of hospital stay, and follow-up duration were obtained from hospital registry notes. Fractures were classified using the AO classification system. At the last follow-up, visual analogue scale (VAS), Tegner activity score, Lysholm knee score, and short form 36 (SF-36) scores were noted.
Results: A total of 30 patients met the inclusion criteria and were included in the study. There were 14 patients in the non-periprosthetic fracture group and 16 patients in the periprosthetic fracture group. The periprosthetic group had significantly lower mean VAS score (p=0.047), Tegner activity score (p=0.015), and Lysholm knee score (p=0.034) than the non-periprosthetic group. The periprosthetic fracture group had significantly inferior quality of life scores compared to non-periprosthetic groups based on SF-36 sub-parameters.
Conclusion: Periprosthetic distal femoral fractures have inferior clinical outcomes and quality of life than non-periprosthetic fractures despite having similar fracture healing rate. Orthopaedic surgeons should be aware of the frailty of the patients caused by prior total knee arthroplasty surgery.
Keywords
Distal femur fracture Periprosthetic fracture Total knee arthroplasty Locking plate fixation nonunion
References
- Arneson TJ, Melton LJ, 3rd, Lewallen DG, O'Fallon WM. Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965-1984. Clin Orthop Relat Res 1988: 188-94.
- Coon MS, Best BJ. Distal Femur Fractures. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 1, 2022.
- Della Rocca GJ, Leung KS, Pape HC. Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma 2011; 25: S66-70.
- Song SJ, Kim KI, Song WJ, Kim DK, Bae DK. Treatment of distal femur fractures with locking plates: comparison of periprosthetic fractures above total knee arthroplasty and non-periprosthetic fractures. Acta Orthop Belg 2014; 80: 380-90.
- Kaufman MW, Rascoe AS, Hii JL, et al. Comparable outcomes between native and periprosthetic fractures of the distal femur. J Knee Surg 2022;10.1055/s-0042-1749604.
- Ricci WM, Loftus T, Cox C, Borrelli J. Locked plates combined with minimally invasive insertion technique for the treatment of periprosthetic supracondylar femur fractures above a total knee arthroplasty. J Orthop Trauma 2006; 20: 190-6.
- Hake ME, Davis ME, Perdue AM, Goulet JA. Modern implant options for the treatment of distal femur fractures. J Am Acad Orthop Surg 2019; 27: 867-75.
- Meek RM, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br 2011; 93: 96-101.
- Pressmar J, Macholz F, Merkert W, Gebhard F, Liener UC. Ergebnisse und Komplikationen der Behandlung periprothetischer Femurfrakturen mit einem winkelstabilen Plattensystem [Results and complications in the treatment of periprosthetic femur fractures with a locked plate system]. Unfallchirurg 2010; 113: 195-202.
- Henderson CE, Bottlang M, Marsh JL, Fitzpatrick DC, Madey SM. Does locked plating of periprosthetic supracondylar femur fractures promote bone healing by callus formation? Two cases with opposite outcomes. Iowa Orthop J 2008; 28: 73-6.
- Streubel PN, Moustoukas MJ, Obremskey WT. Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures. J Orthop Trauma 2013; 27: 22-8.
- Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma 2011; 25 : 8-14.
- Canton G, Giraldi G, Dussi M, Ratti C, Murena L. Osteoporotic distal femur fractures in the elderly: peculiarities and treatment strategies. Acta Biomed 2019; 90: 25-32.
- Hart GP, Kneisl JS, Springer BD, Patt JC, Karunakar MA. Open reduction vs distal femoral replacement arthroplasty for comminuted distal femur fractures in the patients 70 years and older. J Arthroplasty 2017; 32: 202-6.
- Griffin XL, Parsons N, Zbaeda MM, McArthur J. Interventions for treating fractures of the distal femur in adults. Cochrane Database Syst Rev 2015; 2015: CD010606.
- Karam J, Campbell P, David M, Hunter M. Comparison of outcomes and analysis of risk factors for non-union in locked plating of closed periprosthetic and non-periprosthetic distal femoral fractures in a retrospective cohort study. J Orthop Surg Res 2019; 14: 150.
- Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis: does percutaneous plating disrupt femoral blood supply less than the traditional technique? J Orthop Trauma 1999; 13: 401-6.
- Ebraheim NA, Martin A, Sochacki KR, Liu J. Nonunion of distal femoral fractures: a systematic review. Orthop Surg 2013; 5:46-50.
- Hoellwarth JS, Fourman MS, Crossett L, et al. Equivalent mortality and complication rates following periprosthetic distal femur fractures managed with either lateral locked plating or a distal femoral replacement. Injury 2018; 49: 392-7.
- Wadhwa H, Salazar BP, Goodnough LH, et al. Distal femur replacement versus open reduction and internal fixation for treatment of periprosthetic distal femur fractures: a systematic review and meta-analysis. J Orthop Trauma 2022; 36: 1-6.
- Atrey A, Hussain N, Gosling O, et al. A 3 year minimum follow up of Endoprosthetic replacement for distal femoral fractures - An alternative treatment option. J Orthop 2017; 14: 216-22.
- Doshi HK, Wenxian P, Burgula MV, Murphy DP. Clinical outcomes of distal femoral fractures in the geriatric population using locking plates with a minimally invasive approach. Geriatr Orthop Surg Rehabil 2013; 4: 16-20.
- Figgie MP, Goldberg VM, Figgie HE, 3rd, Sobel M. The results of treatment of supracondylar fracture above total knee arthroplasty. J Arthroplasty 1990; 5: 267-76.
- Cordeiro EN, Costa RC, Carazzato JG, Silva Jdos S. Periprosthetic fractures in patients with total knee arthroplasties. Clin Orthop Relat Res 1990: 182-9.
- Hoffmann MF, Jones CB, Sietsema DL, Koenig SJ, Tornetta P, 3rd. Outcome of periprosthetic distal femoral fractures following knee arthroplasty. Injury 2012; 43: 1084-9.
- Abdelmonem AH, Saber AY, El Sagheir M, El-Malky A. Evaluation of the results of minimally invasive plate osteosynthesis using a locking plate in the treatment of distal femur fractures. Cureus 2022; 14: e23617.
- Schutz M, Muller M, Regazzoni P, et al. Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study. Arch Orthop Trauma Surg 2005; 125: 102-8.
Abstract
Keywords
Distal femur fracture Periprosthetic fracture Total knee arthroplasty Locking plate fixation nonunion
References
- Arneson TJ, Melton LJ, 3rd, Lewallen DG, O'Fallon WM. Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965-1984. Clin Orthop Relat Res 1988: 188-94.
- Coon MS, Best BJ. Distal Femur Fractures. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 1, 2022.
- Della Rocca GJ, Leung KS, Pape HC. Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma 2011; 25: S66-70.
- Song SJ, Kim KI, Song WJ, Kim DK, Bae DK. Treatment of distal femur fractures with locking plates: comparison of periprosthetic fractures above total knee arthroplasty and non-periprosthetic fractures. Acta Orthop Belg 2014; 80: 380-90.
- Kaufman MW, Rascoe AS, Hii JL, et al. Comparable outcomes between native and periprosthetic fractures of the distal femur. J Knee Surg 2022;10.1055/s-0042-1749604.
- Ricci WM, Loftus T, Cox C, Borrelli J. Locked plates combined with minimally invasive insertion technique for the treatment of periprosthetic supracondylar femur fractures above a total knee arthroplasty. J Orthop Trauma 2006; 20: 190-6.
- Hake ME, Davis ME, Perdue AM, Goulet JA. Modern implant options for the treatment of distal femur fractures. J Am Acad Orthop Surg 2019; 27: 867-75.
- Meek RM, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br 2011; 93: 96-101.
- Pressmar J, Macholz F, Merkert W, Gebhard F, Liener UC. Ergebnisse und Komplikationen der Behandlung periprothetischer Femurfrakturen mit einem winkelstabilen Plattensystem [Results and complications in the treatment of periprosthetic femur fractures with a locked plate system]. Unfallchirurg 2010; 113: 195-202.
- Henderson CE, Bottlang M, Marsh JL, Fitzpatrick DC, Madey SM. Does locked plating of periprosthetic supracondylar femur fractures promote bone healing by callus formation? Two cases with opposite outcomes. Iowa Orthop J 2008; 28: 73-6.
- Streubel PN, Moustoukas MJ, Obremskey WT. Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures. J Orthop Trauma 2013; 27: 22-8.
- Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma 2011; 25 : 8-14.
- Canton G, Giraldi G, Dussi M, Ratti C, Murena L. Osteoporotic distal femur fractures in the elderly: peculiarities and treatment strategies. Acta Biomed 2019; 90: 25-32.
- Hart GP, Kneisl JS, Springer BD, Patt JC, Karunakar MA. Open reduction vs distal femoral replacement arthroplasty for comminuted distal femur fractures in the patients 70 years and older. J Arthroplasty 2017; 32: 202-6.
- Griffin XL, Parsons N, Zbaeda MM, McArthur J. Interventions for treating fractures of the distal femur in adults. Cochrane Database Syst Rev 2015; 2015: CD010606.
- Karam J, Campbell P, David M, Hunter M. Comparison of outcomes and analysis of risk factors for non-union in locked plating of closed periprosthetic and non-periprosthetic distal femoral fractures in a retrospective cohort study. J Orthop Surg Res 2019; 14: 150.
- Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis: does percutaneous plating disrupt femoral blood supply less than the traditional technique? J Orthop Trauma 1999; 13: 401-6.
- Ebraheim NA, Martin A, Sochacki KR, Liu J. Nonunion of distal femoral fractures: a systematic review. Orthop Surg 2013; 5:46-50.
- Hoellwarth JS, Fourman MS, Crossett L, et al. Equivalent mortality and complication rates following periprosthetic distal femur fractures managed with either lateral locked plating or a distal femoral replacement. Injury 2018; 49: 392-7.
- Wadhwa H, Salazar BP, Goodnough LH, et al. Distal femur replacement versus open reduction and internal fixation for treatment of periprosthetic distal femur fractures: a systematic review and meta-analysis. J Orthop Trauma 2022; 36: 1-6.
- Atrey A, Hussain N, Gosling O, et al. A 3 year minimum follow up of Endoprosthetic replacement for distal femoral fractures - An alternative treatment option. J Orthop 2017; 14: 216-22.
- Doshi HK, Wenxian P, Burgula MV, Murphy DP. Clinical outcomes of distal femoral fractures in the geriatric population using locking plates with a minimally invasive approach. Geriatr Orthop Surg Rehabil 2013; 4: 16-20.
- Figgie MP, Goldberg VM, Figgie HE, 3rd, Sobel M. The results of treatment of supracondylar fracture above total knee arthroplasty. J Arthroplasty 1990; 5: 267-76.
- Cordeiro EN, Costa RC, Carazzato JG, Silva Jdos S. Periprosthetic fractures in patients with total knee arthroplasties. Clin Orthop Relat Res 1990: 182-9.
- Hoffmann MF, Jones CB, Sietsema DL, Koenig SJ, Tornetta P, 3rd. Outcome of periprosthetic distal femoral fractures following knee arthroplasty. Injury 2012; 43: 1084-9.
- Abdelmonem AH, Saber AY, El Sagheir M, El-Malky A. Evaluation of the results of minimally invasive plate osteosynthesis using a locking plate in the treatment of distal femur fractures. Cureus 2022; 14: e23617.
- Schutz M, Muller M, Regazzoni P, et al. Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study. Arch Orthop Trauma Surg 2005; 125: 102-8.
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