Clinical outcome and quality of life of patients with periprosthetic distal femur fractures and retained total knee arthroplasty treated with polyaxial locking plates: a single-center experience

Lotzien, Sebastian; Hoberg, Clemens; Hoffmann, Martin; Schildhauer, Thomas A.

doi:10.1007/s00590-018-2266-z

Cited by 17 publications

(17 citation statements)

References 33 publications

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“…A post-operative score of 41.5 points was observed. Although these data are difficult to compare with our study owing to the different scoring system, an overall moderate outcome can be seen in functional score per Lotzien et al's study (15). This might lead to the theoretical consequence of favouring primary arthroplasty in the case of periprosthetic fractures, especially in the elderly, with the advantage of direct mobilisation with full weightbearing.…”

Section: Discussioncontrasting

confidence: 55%

“…An alternative therapeutic option in the case of stable periprosthetic fractures (Type I and II, per Rorabeck) would be plate fixation such as that studied by Lotzien et al (15,16). They reported a mortality rate of 26.7% after periprosthetic distal femur fractures in their study of 45 patients with a mean age of 74 years (15).…”

Section: Discussionmentioning

confidence: 99%

“…The mortality rate of 23% found in our study was consistent with this. Mortality was associated with higher values in the Charlson Comorbidity Index, again showing the impact of this injury in old and morbid patients (15). Furthermore, functional outcome was analysed by Lotzien et al and measured by the American Short Musculoskeletal Function Assessment Questionnaire, with scores ranging from 0 to 100, with high values indicating poor function (15).…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcome After Replacement of Distal Femur/Proximal Tibia in a Heterogeneous Patient Cohort: Function Following Tumour, Trauma, and Loosening

Graulich

Kranz

Korallus

et al. 2021

In Vivo

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Background: Distal femur and proximal tibia replacements as limb-salvage procedures with good outcome parameters for patients with tumours have been broadly described. However, the overall midterm outcome in a mixed, heterogeneous patient collective is still unclear. Patients and Methods: We retrospectively analysed 59 consecutive patients (33 for primary and 26 for revision surgery) between 1998 and 2017. Indication for implantation was tumour (n=16), periprosthetic fracture (n=14), traumatic fracture (n=14), infection (n=10), aseptic loosening (n=3), and pathological fracture (n=2). The mean follow-up duration was 3 years. Clinical functions were evaluated by Toronto Extremity Salvage Score and Knee Society Score. Knee extension and flexion force were measured. Results: The overall survival rate of arthroplasties was 59% (n=35). Major complications were observed in 36 (61%) patients. During the follow-up period, 14 (24%) patients died. We recorded periprosthetic joint infection in 21 (36%) patients, recurrence of tumour in two (3%), and aseptic implant failure in three (5%). The mean Toronto Extremity Salvage Score was 66±33, and the mean Knee Society Score was 49±30. The mean extension force on the operated side was significantly reduced at 60å nd 180˚ compared to the healthy side (p=0.0151 and p=0.0411, respectively). Conclusion: Distal femur and proximal tibia replacements showed limited clinical function in a heterogeneous patient collective. Indication for implantation should be considered carefully.The overall numbers of mega-arthroplasties are increasing. Although clinical function and patient reported outcomes after primary total knee arthroplasty are well described, existing data on revision arthroplasty, such as replacement of the distal femur and proximal tibia, are rare. Indications for revision surgery/patient-specific mega-arthroplasty at the knee are: (i) Primary implantation such as arthroplasty in cases of large bony defects after tumour resection or primary complex fracture; and (ii) revision surgery after failed total knee arthroplasty in cases of aseptic and septic loosening, periprosthetic fracture, pseudarthrosis, or recurrent prosthetic instability (1-4). The incidence of periprosthetic fractures with large bone defects range between 0.3% and 5.5% after primary total knee arthroplasty and are seen in up to 30% cases after revision arthroplasty, with mortality rates as high as 46% (1, 5).At our clinic, we primarily use the Modular Universal Tumour and Revision System (MUTARS ® ) (Implantcast GmbH, Buxtehude, Germany) for large bony defects at the distal femur and proximal tibia, which is a well-established system (6). The stem is made of titanium alloy (TiAl6V4) in the cementless implant and of CoCrMo alloy in the cemented version (1). Although good leg-length alignment and good clinical function can be achieved, implantation is associated with high reoperation rates of 25-50% (1, 3, 5-7). The opportunity to return to daily living after distal femur/proximal tibial replacement is impaired ...

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Outcome After Replacement of Distal Femur/Proximal Tibia in a Heterogeneous Patient Cohort: Function Following Tumour, Trauma, and Loosening

Graulich

Kranz

Korallus

et al. 2021

In Vivo

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“…In 2018, Lotzien et al [19] have published a retrospective study regarding periprosthetic femoral fractures after TKA, which included 45 patients. Interestingly, the aim of the study was to assess the quality of life and functional status by using 3 parameters: the SMFA-D score, mortality rate and union rate.…”

Section: Articles Covering Femoral Fractures After Tkamentioning

confidence: 99%

Periprosthetic fractures after total knee arthroplasty: review

Creţu

Șerban

Zaharia

et al. 2019

Romanian Journal of Orthopaedic Surgery and Traumatology

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This review of literature classifies and describes the most common periprosthetic fractures after total knee arthroplasty. Classification systems are usually considered useful when they describe the condition and offer guidelines for the management of a certain condition and are specific and comprehensive. The Lewis and Rorabeck classification can be used to describe these fractures. The review not only provides the results of the classic techniques, but also new and combined techniques tried by some of the authors. For this review, only original studies, published between 2013 and 2019, were selected. The articles included in the database were selected from PubMed, ScienceDirect and SpringerLink. The searched keywords used to identify the articles were TKA, periprosthetic fractures and total knee arthroplasty. The aim of this paper was to review the clinical studies related to periprosthetic fractures after total knee arthroplasty from the last six years, in order to understand current perspectives, epidemiology, treatment, and management.In conclusion, periprosthetic fractures after total knee arthroplasty represent an important problem in medicine, but due to the low number of cases. Despite the increase in incidence, guidelines are mostly based on retrospective studies, personal observations, and expert opinion. The consensus is that treatment should be assigned depending on the patient's profile and the fracture's characteristics. Further studies should be performed in order to guide future practitioners in the treatment of periprosthetic fractures.

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“…Where fractures are proximal to well-fixed femoral components with adequate bone stock, they are usually managed with fixation, as opposed to revision arthroplasty [ 4 ]. Although proximal diaphyseal-type fractures can be treated with retrograde femoral nailing [ 8 ], where fixation is undertaken for more distal fractures a lateral locking plate (LLP) is typically used, with or without additional augmentation [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Immediate weight-bearing is safe following lateral locked plate fixation of periprosthetic distal femoral fractures

Keenan

Ross

Magill

et al. 2021

Knee Surg & Relat Res

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Purpose This study aimed to determine whether unrestricted weight-bearing as tolerated (WBAT) following lateral locking plate (LLP) fixation of periprosthetic distal femoral fractures (PDFFs) is associated with increased failure and reoperation, compared with restricted weight-bearing (RWB). Materials and methods In a retrospective cohort study of consecutive patients with unilateral PDFFs undergoing LLP fixation, patients prescribed WBAT were compared with those prescribed 6 weeks of RWB. The primary outcome measure was reoperation. Kaplan–Meier and Cox multivariable analyses were performed. Results There were 43 patients (mean age 80.9 ± 11.7 years, body mass index 26.8 ± 5.7 kg/m2 and 86.0% female): 28 WBAT and 15 RWB. There were more interprosthetic fractures in the RWB group (p = 0.040). Mean follow-up was 3.8 years (range 1.0–10.4). Eight patients (18.6%) underwent reoperation. Kaplan–Meier analysis demonstrated no difference in 2-year survival between WBAT (80.6%, 95% CI 65.3–95.9) and RWB (83.3%, 95% CI 62.1–100.0; p = 0.54). Cox analysis showed increased reoperation risk with medial comminution (hazard ratio 10.7, 95% CI 1.5–80; p = 0.020) and decreased risk with anatomic reduction (hazard ratio 0.11, 95% CI 0.01–1.0; p = 0.046). Immediate weight-bearing did not significantly affect the risk of reoperation compared with RWB (relative risk 1.03, 95% CI 0.61–1.74; p = 0.91). Conclusions LLP fixation failure was associated with medial comminution and non-anatomic reductions, not with postoperative weight-bearing. Medial comminution should be managed with additional fixation. Weight-bearing restrictions additional to this appear unnecessary and should be avoided.

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Clinical outcome and quality of life of patients with periprosthetic distal femur fractures and retained total knee arthroplasty treated with polyaxial locking plates: a single-center experience

Cited by 17 publications

References 33 publications

Clinical Outcome After Replacement of Distal Femur/Proximal Tibia in a Heterogeneous Patient Cohort: Function Following Tumour, Trauma, and Loosening

Clinical Outcome After Replacement of Distal Femur/Proximal Tibia in a Heterogeneous Patient Cohort: Function Following Tumour, Trauma, and Loosening

Periprosthetic fractures after total knee arthroplasty: review

Immediate weight-bearing is safe following lateral locked plate fixation of periprosthetic distal femoral fractures

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