Minimally invasive plate osteosynthesis with dual plating for periprosthetic distal femoral fractures following total knee arthroplasty

Abstract

Introduction Adequate treatment for periprosthetic distal femur fractures is challenging because of various reasons, including severe osteoporosis and distal fragments that are too small or too distal. We have introduced a new surgical technique for dual plating of periprosthetic distal femur fractures following total knee arthroplasty (TKA) and determined the clinical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with a dual locking compression plate (LCP). Materials and methods Between January 2010 and July 2019, 18 patients [mean age, 74.8 (68–89) years; average follow-up period, 14.8 (12–43) months] underwent MIPO with distal femoral LCP laterally and proximal humeral internal locking system (PHILOS) medially for periprosthetic distal femoral fractures following TKA. The minimum follow-up was 1 year. The clinical and radiological outcomes were assessed using the modified WOMAC scores, knee range of motion, time to callus formation, time to union, and complications of malunion, nonunion, and shortening. Results The average time to union was 18.4 weeks (range, 10–51 weeks) and to callus formation was 7.8 weeks (range, 2–14 weeks). At the 1-year follow-up, the average JLETS was 37.6 (range, 24–53), average knee ROM was 110.3° (range, 80–135°), and average varus-valgus angles of the distal femur were 3.2° (range, −2.9–10.5°). No nonunion, broken plates, or implant failure occurred. Malunion occurred in three patients. Conclusion MIPO with dual LCP is a reliable method for stabilizing periprosthetic distal femoral fractures following TKA, with satisfactory bone union rates and low complication rates.

Plating for Intra-articular Fractures of the Distal Femur: Functional and Radiological Outcomes

“…In a study by Kanabar et al, the time for union ranged from 12 to 19 weeks [ 20 ]. Similar results were found in a study done in 2021 by Park et al, where the mean time for the union was 18.4 weeks [ 21 ]. Another study by Kim et al in 2017 revealed that the mean time for the union was 17.1 weeks [ 22 ].…”

“…al., the time for union ranged from 12 to 19 weeks[20]. Similar results were found in a study done in 2021 byPark et al., where the mean time for the union was 18.4 weeks[21]. Another study byKim et al in 2017 revealed that the mean time for the union was 17.1 weeks[22].Of note, 24 cases (80%) had full flexion achieved at or above 120 degrees, while four patients (14.5%) had flexion between 90 and 120 degrees and the remaining two patients had flexion below 90 degrees.…”

Fixation techniques for periprosthetic femur fractures around total knee arthroplasty: a systematic review

“…Four studies using the DP technique were included for the final data analysis. 6,32,37,38 Cicek et al reported on a series of 22 patients treated with the DP technique for Su type III fractures. 6 The mean time to union was 4.3 mo (SD ± 0.9 mo).…”

Comparison of locking compression plate and distal femoral replacement for periprosthetic distal femoral fractures: a retrospective study

“…A previous study reported excellent function (KSS 94 and KSFS 89.5) and fewer complications for very low PPDFFs using double-locked plating. 27 In addition, dual plating with minimal invasion or intramedullary fibular strut allograft has shown satisfactory outcomes. 26 , 27 However, these were observational studies without control groups.…”

“… 27 In addition, dual plating with minimal invasion or intramedullary fibular strut allograft has shown satisfactory outcomes. 26 , 27 However, these were observational studies without control groups. Further research comparing the double-locking plate and DFR for low PDFFs is required.…”