Distal femoral fractures after knee arthroplasty

Weber, Dominique; Peter, Robin

doi:10.1007/s002640050359

Cited by 11 publications

(6 citation statements)

References 16 publications

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“…30,31 Furthermore, several studies demonstrate falls after TKA surgery contribute to periprosthetic joint-related complications, including fractures. [45][46][47] We theorize increased risk of fall in patients with sarcopenia may account for the increased frequency of implant-related complications which were observed in the study cohort.…”

Section: Discussionmentioning

confidence: 92%

Comparative Analysis on the Effects of Sarcopenia following Primary Total Knee Arthroplasty: A Retrospective Matched-Control Analysis

et al. 2020

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AbstractDespite the high incidence of sarcopenia in the orthopaedic community, studies evaluating the influence of sarcopenia following primary total knee arthroplasty (TKA) are limited. Therefore, the purpose of this study is to determine if sarcopenic patients undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS); (2) medical complications; (3) implant-related complications; (4) fall risk; (5) lower extremity fracture risk; and (6) costs of care. Sarcopenia patients were matched to controls in a 1:5 ratio according to age, sex, and medical comorbidities. The query yielded 90,438 patients with (n = 15,073) and without (n = 75,365) sarcopenia undergoing primary TKA. Primary outcomes analyzed included: in-hospital LOS, 90-day medical complications, 2-year implant-related complications, fall risk, lower extremity fracture risk, and costs of care. A p-value of less than 0.05 was considered statistically significant. Patients with sarcopenia undergoing primary TKA had greater in-hospital LOS (4 vs. 3 days, p < 0.0001). Sarcopenic patients were also found to have increased incidence and odds of 90-day medical complications (2.9 vs. 1.1%; odds ratio [OR] = 2.83, p < 0.0001), falls (0.9 vs. 0.3%; OR = 3.54, p < 0.0001), lower extremity fractures (1.0 vs. 0.2%; OR = 5.54, p < 0.0001), and reoperation (0.9 vs. 0.5%; OR = 1.87, p < 0.0001). Additionally, sarcopenic patients had greater 2-year implant-related complications (4.3 vs. 2.4%; OR = 1.80, p < 0.0001), as well as day of surgery ($52,900 vs. 48,248, p < 0.0001), and 90-day ($68,303 vs. $57,671, p < 0.0001) costs compared with controls. This analysis of over 90,000 patients demonstrates that patients with sarcopenia undergoing primary TKA have greater in-hospital LOS, increased odds of 90-day medical complications, falls, lower extremity fractures, and reoperations. Additionally, sarcopenia was associated with greater 2-year implant-related complications, day of surgery costs, and 90-day costs. The study is useful as it can allow orthopaedic surgeons to properly educate these patients of the potential complications which may occur following their surgery.

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Section: Discussionmentioning

confidence: 92%

Comparative Analysis on the Effects of Sarcopenia following Primary Total Knee Arthroplasty: A Retrospective Matched-Control Analysis

et al. 2020

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“…Ultimately, 29 articles were included in this systematic review. A total of 415 fractures that were treated either nonoperatively (Short et al 1981, Sisto et al 1985, Cain et al 1986, Merkel and Johnson 1986, Culp et al 1987, Bogoch et al 1988, Nielsen et al 1988, Cordeiro et al 1990, Garnavos et al 1994, Moran et al 1996, operatively by conventional non-locking plating techniques (Short et al 1981, Sisto et al 1985, Cain et al 1986, Merkel and Johnson 1986, Culp et al 1987, Bogoch et al 1988, Nielsen et al 1988, Cordeiro et al 1990, Healy et al 1993, Zehntner and Ganz 1993, Garnavos et al 1994, Moran et al 1996, Oschner and Pfister 1999, Weber and Peter 1999, Al-Shawi et al 2002, Wang and Wang 2002, Althausen et al 2003, Bezwada et al 2004, retrograde intramedullary nailing (Culp et al 1987, Garnavos et al 1994, McLaren et al 1994, Weber et al 2000, Wick et al 2001, 2004, Althausen et al 2003, Bezwada et al 2004, Gliatis et al 2005, locked submuscular plating techniques (Kregor et al 2001, Althausen et al 2003, Wick...…”

Section: Resultsmentioning

confidence: 99%

Treatment of acute distal femur fractures above a total knee arthroplasty: Systematic review of 415 cases (1981–2006)

et al. 2008

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Background There is no consensus on the best treatment for periprosthetic supracondylar fracture.Material and methods We systematically summarized and compared results of different fixation techniques in the management of acute distal femur fractures above a total knee arthroplasty (TKA). Several databases were searched (Medline, Cochrane library, OTA and AAOS abstract databases) and baseline and outcome parameters were abstracted.Results We extracted data from 29 case series with a total of 415 fractures. The following outcomes were noted: a nonunion rate of 9%, a fixation failure rate of 4%, an infection rate of 3%, and a revision surgery rate of 13%. Retrograde nailing was associated with relative risk reduction (RRR) of 87% (p = 0.01) for developing a nonunion and 70% (p = 0.03) for requiring revision surgery compared to traditional (non-locking) plating methods. Point estimates also suggested risk reductions for locking plates, although these were not statistically significant (57% for nonunion, p = 0.2; 43% for revision surgery, p = 0.23) compared to traditional plating. RRRs for nonunion and revision surgery were also statistically significantly lower for retrograde nailing and locking plates compared to nonoperative treatment.Interpretation Modern-day treatment methods are superior to conventional treatment options in the management of distal femur fractures above TKAs. The results should be interpreted with caution, due to the lack of randomized controlled trials and the possible selection bias in case series.

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“…These include stabilization with buttress plates, condylar blade-plates, dynamic compression plates, external fixation, intramedullary nailing and revision arthroplasty with and without allograft and massive prostheses [2,3,5,6,9,11,12,16,19,20]. Most of the published series dealing with surgical treatment options present open techniques with utilization of plates.…”

Section: Discussionmentioning

confidence: 99%

Supracondylar nailing of distal periprosthetic femoral fractures

Weber¹,

Pomeroy²,

Schaper³

et al. 2000

International Orthopaedics

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Seven patients who sustained complex distal femoral fractures above total knee arthroplasties all treated by supracondylar (retrograde) femoral nailing were retrospectively evaluated. All the patients demonstrated uncomplicated postoperative follow-ups and returned to weight bearing between 2 and 3 months after surgery. No delayed healing occurred and alignment of the femur was satisfactory.Résumé Nous avons réalisé une étude rétrospective comprenant sept fractures periprothetiques complexes du fémur distal chez sept porteurs de PTG. Toutes les fractures ont ete traitees par enclouage rétrograde du fémur. L'evolution post-opératoire et la réeducation à la marche étaient sans particularités chez tous les patients. Toutes les fractures ont consolidés sans problemes avec un bon alignement.

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Distal femoral fractures after knee arthroplasty

Cited by 11 publications

References 16 publications

Comparative Analysis on the Effects of Sarcopenia following Primary Total Knee Arthroplasty: A Retrospective Matched-Control Analysis

Comparative Analysis on the Effects of Sarcopenia following Primary Total Knee Arthroplasty: A Retrospective Matched-Control Analysis

Treatment of acute distal femur fractures above a total knee arthroplasty: Systematic review of 415 cases (1981–2006)

Supracondylar nailing of distal periprosthetic femoral fractures

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