Femoral Periprosthetic Fractures after Total Knee Arthroplasty: New Surgically Oriented Classification with a Review of Current Treatments

Rhee, Sook‐Hee; Cho, Jae-Young; Choi, Yoon Young; Sawaguchi, Takahiro; Suh, Jeung Tak

doi:10.5792/ksrr.17.036

Cited by 15 publications

(6 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The fractures following push-off measurements were merely the result of the used test setup, since the observed posterior fracture pattern, depicted in Fig. 5c, has not been reported clinically [35].…”

Section: Discussionmentioning

confidence: 97%

Experimental measurements of femoral primary stability in two cementless posterior-stabilized knee replacement implants

Anijs¹,

Wolfson²,

Mercer³

et al. 2022

Medical Engineering & Physics

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 97%

Experimental measurements of femoral primary stability in two cementless posterior-stabilized knee replacement implants

Anijs¹,

Wolfson²,

Mercer³

et al. 2022

Medical Engineering & Physics

View full text Add to dashboard Cite

“…18,34 Traditionally, fractures distal to the anterior flange have been considered "too distal to nail," a concept that is based off older intramedullary nail designs that had limited ability to achieve fixation in small distal segments. 9,35 Modern intramedullary nails have increased distal interlock options and have also added the ability to achieve fixed angle stability through the interlocks. In light of these advances, it is important to re-evaluate whether there is a minimum amount of distal bone required for successful rIMN.…”

Section: Discussionmentioning

confidence: 99%

Retrograde Intramedullary Nailing Versus Locked Plating for Extreme Distal Periprosthetic Femur Fractures: A Multicenter Retrospective Cohort Study

Van Rysselberghe,

Seltzer,

Lawson

et al. 2024

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

OBJECTIVE: To compare clinical and radiographic outcomes following retrograde intramedullary nailing vs locked plating of “extreme distal” periprosthetic femur fractures, defined as those which contact or extend distal to the anterior flange. METHODS Design: Retrospective review Setting: Eight academic level I trauma centers Patient Selection Criteria: adult patients with periprosthetic distal femur fractures at or distal to the anterior flange (OTA/AO 33B-C[VB1]) treated with rIMNs or LPs. Outcome Measures and Comparisons: The primary outcome was reoperation to promote healing or to treat infection (re-operation for elective removal of symptomatic hardware was excluded from this analysis). Secondary outcomes included nonunion, delayed union, fixation failure, infection, overall reoperation rate, distal femoral alignment, and ambulatory status at final follow-up. Compared, were patients treated with rIMNs or LPs. RESULTS: 71 patients treated with rIMNs and 224 patients treated with LPs were included. The rIMN group had fewer points of fixation in the distal segment (rIMN: 3.5 +/- 1.1 vs LP: 6.0 +/- 1.1, p<0.001) and more patients who were allowed to weight-bear as tolerated immediately post-operatively (rIMN: 45%; LP: 9%, p<0.01). Reoperation to promote union and/or treat infection was 8% in the rIMN group and 16% in the LP group (p=0.122). There were no significant differences in nonunion (p >0.999), delayed union (p=0.079), fixation failure (p>0.999), infection (p=0.084), or overall reoperation rate (p>0.999). Significantly more patients in the rIMN group were ambulatory without assistive devices at final follow-up (rIMN: 35%, LP: 18%, p=0.008). CONCLUSIONS: Retrograde intramedullary nailing of extreme distal periprosthetic femur fractures has similar complication rates compared to locked plating, with a possible advantage of earlier return to weight-bearing. Surgeons can consider this treatment strategy in all fractures with stable implants and amenable prosthesis geometry, even extreme distal fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

show abstract

“…The modern LP and RIMN technology have been demonstrated to be superior in biomechanical and clinical outcomes in contrast with conventional non-locked plating[ 12 ]. Due to the similarity in application period and fracture healing biomechanism between LP and RIMN, numerous comparative studies have been carried out[ 13 ]. Despite of their specific merits as well as the different indications attributing from their unique fixation mechanism, recent systematic reviews and meta-analysis consistently demonstrated no statistically significant differences in clinical results, time to fracture union, complication rate, or the range of postoperative motion between the two treatment options (Table 1 )[ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Modified fixation for periprosthetic supracondylar femur fractures: Two case reports and review of the literature

Li¹,

Wu²,

Chen³

2022

World J Clin Cases

View full text Add to dashboard Cite

BACKGROUND Periprosthetic supracondylar femoral fractures (PSFs) present a challenge in terms of optimizing fixation in patients with poor bone quality. Surgical treatment and peri-operative management of PSFs in the elderly remain a burden for orthopedic surgeons. Among different treatment options, locking plate (LP) and retrograde intramedullary nail (RIMN) have shown favorable results. However, reduced mobility and protected weight-bearing are often present in the postoperative older population. With a purpose of allowing for early weight-bearing, a modified nail plate combination (NPC) was redesigned for PSF management. CASE SUMMARY In our cases, two elderly osteoporotic female underwent total knee arthroplasty (TKA), and then suffered from low energy trauma onto their knees after falling to the floor. Plain radiographs or computed tomography scans demonstrated oblique or transverse PSFs, both of which occurred at the distal femur above TKA. The modified NPC technique was performed for treatment of PSFs. The patient was made foot flat weight bearing in 1 wk. At 6-mo follow-up, the union was ultimately achieved using modified NPC with satisfactory implant outcomes. CONCLUSION Neither LP nor RIMN alone may provide adequate support to allow for union in circumstances where the patient has severely osteopenic bone. Therefore, developing a modified implant offer an alternative choice for treating PSFs. These two cases revealed that this technique is a viable option for the geriatric osteoporotic PSFs, offering safe, early weight bearing and favorable clinical outcomes.

show abstract

Femoral Periprosthetic Fractures after Total Knee Arthroplasty: New Surgically Oriented Classification with a Review of Current Treatments

Cited by 15 publications

References 55 publications

Experimental measurements of femoral primary stability in two cementless posterior-stabilized knee replacement implants

Experimental measurements of femoral primary stability in two cementless posterior-stabilized knee replacement implants

Retrograde Intramedullary Nailing Versus Locked Plating for Extreme Distal Periprosthetic Femur Fractures: A Multicenter Retrospective Cohort Study

Modified fixation for periprosthetic supracondylar femur fractures: Two case reports and review of the literature

Contact Info

Product

Resources

About