Distal Femoral Replacement and Periprosthetic Joint Infection After Non-Oncological Reconstruction: A Retrospective Analysis

Sukhonthamarn, Kamolsak; Strony, John; Patel, Urvi; Brown, Scot; Nazarian, David G.; Parvızı, Javad; Klein, Gregg R.

doi:10.1016/j.arth.2021.08.013

Cited by 11 publications

(11 citation statements)

References 16 publications

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“…Regarding demographic characteristics, this study reveals a higher incidence of DFFs or PDFFs in older women with comorbidities such as osteoporosis, obesity, rheumatic disease, diabetes mellitus, and neurologic disorders, as described in the literature ( 21 - 25 ).…”

Section: Discussionsupporting

confidence: 57%

“…The mean operative for DFR after DFF or PDFF reported in the literature varies widely. Jassim et al , in their case series, described a mean operative time of 140 minutes ( 24 ), Matar et al reported a mean operative time of 128 minutes ( 22 ), while Sukhontamarn et al showed a mean operative time of 125 minutes ( 25 ). In this study, the mean operative time is slightly higher than reported in the literature; however, no major intraoperative complications were observed.…”

Section: Discussionmentioning

confidence: 99%

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Should megaprosthesis implants be a viable option in elderly patients after distal femur and periprosthetic distal femur fractures?—a retrospective cohort study

Risitano,

D’Antonio,

Bosco

et al. 2023

Ann Joint

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Background Distal femur fractures (DFF) and periprosthetic distal femur fractures (PDFF) in elderly patients are challenging to manage, often requiring the use of distal femur replacement (DFR) implants to manage severe bone loss and comminution. The study’s main purpose was to analyze outcomes and complications of DFR implant after DFF or PDFF at our institution to understand the feasibility and reliability of this treatment considering a review of the current literature. Methods Fourteen consecutive patients undergoing total knee replacement with megaprosthesis implant from January 1st, 2017 to January 1st, 2021, at our institution were retrospectively analyzed. Inclusion criteria were age ≥65 years and DFF or PDFF after primary total knee arthroplasties (TKA) implantation. Patient-reported outcome measures (PROMs) such as Knee Society Score (KSS) and Oxford Knee Score (OKS) were analyzed, as well as radiographic pre- and post-operative imaging. Complications were recorded from the early postoperative period to the last follow-up. Results Nine patients were diagnosed with PDFF and five with DFF. At a mean follow-up of 30.7 months (range, 12 to 69 months), the mean KSS knee score was 79.5±11.2; the mean KSS function score was 69.0±17.9. The mean OKS was 31.6±8.9. The mean age at intervention was 82.1±7.6 years. Two delayed wound closures and one chronic prosthetic joint infection (PJI) were observed. No death was observed at the last follow-up. Conclusions Megaprosthesis implants could be a suitable option in elderly, arthritic patients diagnosed with complicated DFFs and PDFFs, allowing joint function preservation and a rapid return to daily activities. DFR remains an intervention burdened by devastating complications that must be considered in the treatment choice.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Should megaprosthesis implants be a viable option in elderly patients after distal femur and periprosthetic distal femur fractures?—a retrospective cohort study

Risitano,

D’Antonio,

Bosco

et al. 2023

Ann Joint

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“…25 By contrast, infected arthroplasty often requires staged implant revision and, in the case of failed revision, can result in knee arthrodesis or amputation. 26…”

Section: Discussionmentioning

confidence: 99%

“…25 By contrast, infected arthroplasty often requires staged implant revision and, in the case of failed revision, can result in knee arthrodesis or amputation. 26 Authors have posited that the improved mobility after DFR or TKA for distal femur fractures may reduce morbidity and mortality. 27 However, not only have cohort studies failed to demonstrate a significant mobility advantage 5 but also our study and the existing literature have failed to identify significant differences in short-term outcomes between the 2 treatment options.…”

Section: Discussionmentioning

confidence: 99%

Geriatric Distal Femur Fractures: Equivalent Long-Term Reoperation Rates Between Fixation and Primary Arthroplasty

Shi

Upfill‐Brown

Brodke

et al. 2023

Journal of Orthopaedic Trauma

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“…Much of the survivorship data regarding cemented DFRs and PTRs come from the oncologic literature, with aseptic loosening rates of 4% to 10% at 4 to 12 years and higher rates approaching 30% at 15 years in some studies [41,80,94,152,160,178]. Regarding contemporary cemented DFR for nononcologic reasons, the available literature suggests all-cause revision rates range from approximately 18% to 24% at 5 years, with one recent study demonstrating rates of 17 and 27.5% for aseptic loosening and all-cause revision, respectively, at 10 years [191,199,217]. Previously instrumented canals, which may be sclerotic in nature, can perform worse with fully cemented stems in the revision complex modular knee replacement scenario, as cement needs a more porous or cancellous surface for interdigitation and durable fixation.…”

Section: Question 2 What Are the Indications To Use Hybrid Stem Fixat...mentioning

confidence: 99%

Management of Bone Loss in Revision Total Knee Arthroplasty: An International Consensus Symposium

Sculco,

Flevas,

Jerabek

et al. 2024

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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The evaluation, classification, and treatment of significant bone loss after total knee arthroplasty (TKA) continue to be a complex and debated topic in revision TKA (rTKA). Despite the introduction of new evidence and innovative technologies aimed at addressing the approach and care of severe bone loss in rTKA, there is no single document that systematically incorporates these newer surgical approaches. Therefore, a comprehensive review of the treatment of severe bone loss in rTKA is necessary. The Stavros Niarchos Foundation Complex Joint Reconstruction Center Hospital for Special Surgery, dedicated to clinical care and research primarily in revision hip and knee replacement, convened a Management of Bone Loss in Revision TKA symposium on June 24, 2022. At this meeting, the 42 international invited experts were divided into groups; each group was assigned to discuss questions related to 1 of the 4 topics: (1) assessing preoperative workup and imaging, anticipated bone loss, classification system, and implant surveillance; (2) achieving durable fixation in the setting of significant bone loss in revision TKA; (3) managing patellar bone loss and the extensor mechanism in cases of severe bone loss; and (4) considering the use of complex modular replacement systems: hinges, distal femoral, and proximal tibial replacements. Each group came to consensus, when possible, based on an extensive literature review and interactive discussion on their group topic. This document reviews each these 4 areas, the consensus of each group, and directions for future research.

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Distal Femoral Replacement and Periprosthetic Joint Infection After Non-Oncological Reconstruction: A Retrospective Analysis

Cited by 11 publications

References 16 publications

Should megaprosthesis implants be a viable option in elderly patients after distal femur and periprosthetic distal femur fractures?—a retrospective cohort study

Should megaprosthesis implants be a viable option in elderly patients after distal femur and periprosthetic distal femur fractures?—a retrospective cohort study

Geriatric Distal Femur Fractures: Equivalent Long-Term Reoperation Rates Between Fixation and Primary Arthroplasty

Management of Bone Loss in Revision Total Knee Arthroplasty: An International Consensus Symposium

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