Management of periprosthetic distal femur fractures using distal femoral arthroplasty and fixation - Comparative study of outcomes and costs

Tandon, Tarang; Tadros, Baha John; Avasthi, Adhish; Hill, R. D.; Rao, Madhu

doi:10.1016/j.jcot.2019.05.015

Cited by 24 publications

(28 citation statements)

References 20 publications

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“…The outcomes including length of stay and mortality are discussed and summarised in Table 1 [3,[9][10][11][12][13][14]. Table 1 includes five studies that directly compared the two surgical techniques.…”

Section: Resultsmentioning

confidence: 99%

“…With regard to complications, a direct comparison study observed no difference between the two groups of patients with post-operative complications; however, one in five patients in the fixation cohort developed a non-union [ 3 ], which is consistent with the literature regarding non-union rates [ 7 ]. Another study reported that, at one year, there were no complications in the DFR cohort compared to one failure of fixation, six malunions, and two infections in the fixation cohort [ 12 ]. A study examining a group of patients treated with DFR found implant-related complications in 11% or in two cases of their sample.…”

Section: Reviewmentioning

confidence: 99%

“…The IM device is load sharing and thus permits early weight-bearing, helping to reduce the risk of complications associated with immobility. A study comparing DFR with locked lateral plating for patients with a peri-prosthetic distal femur fracture found that all patients were fully weight-bearing in under two days following DFR, while there was an average of 11 weeks to full weight-bearing for patients post-fixation [ 12 ]. However, when directly compared for injuries around native joints, the time to discharge was 7.5 days in those treated with ORIF and 7.3 in those treated with DFR [ 3 ].…”

Section: Reviewmentioning

confidence: 99%

“…The implant cost for a DFR exceeds that of the plate and screws used for fixation. However, taking into account time until hospital discharge, the patient being fully weight-bearing, and possible community support, the overall costs of the procedures are similar, with an approximate overall cost of £10,000 for DFR and £9,800 for fixation [ 9 , 12 ]. Despite the slightly higher cost, the favourable outcomes with regard to weight-bearing and post-operative ambulatory status highlight an overall greater cost-benefit when using DFR compared to fixation techniques.…”

Section: Reviewmentioning

confidence: 99%

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Distal Femoral Replacement as a Primary Treatment Method for Distal Femoral Fractures in the Elderly

Onubogu¹,

Relwani²,

Grewal³

et al. 2021

Cureus

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Distal femoral fractures account for 3-6% of all femoral fractures with a similar demographic as patients suffering from proximal femoral fractures. The mortality risk can be high in such injuries, which has prompted NHS England to extend the scope of the Best Practice Tariff to include all fragility fractures of the femur. Poor bone quality, intra-articular extension, and significant comminution can make these fractures difficult to manage with fixation techniques, while early mobilisation is a key outcome in the treatment of this injury.In this study, a comprehensive literature search was performed based on keywords, and abstracts were reviewed to identify relevant articles. The following factors were analysed: time to surgery, time to full weight-bearing, the average hospital stay, post-operative mobility status, and complications.A total of 233 abstracts were identified using the pre-determined search criteria, and, subsequently, articles were excluded following author review. A total of 10 relevant articles were included in this review, with five used for review and comparison between distal femoral replacement (DFR) and fixation. This resulted in a sample of 200 patients treated with DFR with over 87% ambulatory at follow-up and a re-operation rate of 13.3% compared to 78% and 13.5%, respectively, in those treated with open reduction internal fixation (ORIF) procedure.Despite a limited pool of evidence, the literature suggests that DFR offers an option that potentially allows immediate weight-bearing and leaves most patients ambulatory at follow-up. Although DFR is more costly than other operative techniques, it avoids complications associated with fixation such as non-union and can reduce the risk of further surgery through direct complications or a need for delayed arthroplasty, which is deemed more complex secondary to fixation. Early mobilisation is a key step in reducing morbidity and mortality among this cohort of patients, and a procedure such as DFR should be more widely considered to help achieve this outcome.

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Section: Resultsmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Distal Femoral Replacement as a Primary Treatment Method for Distal Femoral Fractures in the Elderly

Onubogu¹,

Relwani²,

Grewal³

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“…Verma et al 5 provide tips for revising Vancouver B2 and B3 periprosthetic fractures around THA which are associated with the loose primary femoral prosthesis. Tandon et al 6 suggest that distal femoral arthroplasty may be a suitable alternative to osteosynthesis for periprosthetic fractures around Total Knee Arthroplasty among patients in the eighth decade of life.…”

mentioning

confidence: 99%