Equivalent mortality and complication rates following periprosthetic distal femur fractures managed with either lateral locked plating or a distal femoral replacement

Hoellwarth, Jason Shih; Fourman, Mitchell S.; Crossett, Lawrence S.; Goodman, Mark A.; Siska, Peter A.; Moloney, Gele; Tarkin, Ivan S.

doi:10.1016/j.injury.2017.11.040

Cited by 69 publications

(86 citation statements)

References 53 publications

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“…Furthermore, by virtue of the treatment, the problem of non-union is eliminated. Significant concerns for regular adoption of this practice include the safety of performing complex surgery on frail patients, an increased risk of associated complications most especially infection and costs involved [40–42]. Recent studies reporting on the viability of distal femoral replacement as an option are promising [43–45], and future research efforts are required to better prove the safety and efficacy of this practice.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Background The primary aim was to compare the outcomes of locked plating of closed distal femur periprosthetic and non-periprosthetic fractures by testing the hypothesis that outcomes would be worse in the periprosthetic group. The secondary aim of this study was to identify risk factors for non-union. Methods A single-center study over an 8-year period utilizing a retrospective cohort design was performed. Sixty-eight patients with periprosthetic fractures and 57 patients with non-periprosthetic fractures met inclusion criteria for the study. There was a significant difference between groups in mean age (80.1 years periprosthetic vs. 70.9 years non-periprosthetic ( p < 0.001)). Statistical analysis between groups was used to assess the outcomes of time to union, incidence of non-union, post-operative functionality, incidence of complications, progression to revision surgery, and mortality. A secondary multivariable analysis was used to assess risk factors for non-union and factors positively associated with union. Results There were no significant differences in outcomes between groups. Union rates were 83.8% (57/68) in the periprosthetic group and 78.9% (45/57) in the non-periprosthetic group ( p = 0.648). Comminution was identified as a significant risk factor for non-union ( p = 0.005). Use of a submuscular technique had a significant positive association with union ( p = 0.006). Conclusions Outcomes of surgical treatment for periprosthetic and non-periprosthetic distal femur fractures are similar. There is a significant risk of non-union in locked plating of both groups.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…13 In addition, Hoellwarth et al showed 81% of the patients with DFR maintaining mobility at 1 year. 16…”

Section: Discussionmentioning

confidence: 99%

Distal Femoral Replacement for Periprosthetic Fractures around Total Knee Arthroplasty: When and How?

Schmidt

2019

J Knee Surg

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Periprosthetic fractures around total knee arthroplasty have become more common with the increasing incidence of total knee arthroplasty. These fractures are challenging to treat, especially in older patients with poor bone stock. Although open reduction internal fixation remains the most common treatment, revision with distal femoral replacement has become popular in recent years. Careful evaluation and planning are required to have successful outcomes. We present a review of distal femoral replacement in periprosthetic fractures around the total knee arthroplasty, along with surgical technique, and pearls and pitfalls.

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“…A retrospective study conducted by Hoellwarth et al [28] in 2017 focused on the comparison between locking plates for 87 patients and distal femoral arthroplasty for 53 patients, considering mortality, the motion of the knee and the need for further surgery. Their study suggested that there are no statistical differences between these two methods, but treatment should always be adequate for the patient's bone quality, quality of life before treatment, comorbidities and fracture location as well.…”

Section: Other Surgical Treatmentsmentioning

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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Equivalent mortality and complication rates following periprosthetic distal femur fractures managed with either lateral locked plating or a distal femoral replacement

Cited by 69 publications

References 53 publications

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

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

Distal Femoral Replacement for Periprosthetic Fractures around Total Knee Arthroplasty: When and How?

Periprosthetic fractures after total knee arthroplasty: review

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