Periprosthetic supracondylar femoral fractures following total knee arthroplasty: clinical comparison and related complications of the femur plate system and retrograde-inserted supracondylar nail

Abstract

BackgroundThe purpose of this study is to analyze the clinical results and related complications of the femur plate system (FP) and the retrograde-inserted supracondylar nail (RISN).Materials and methodsThe study included 42 cases of periprosthetic supracondylar femoral fractures (PSF) proximal to posterior stabilized total knee arthroplasty between 2005 and 2009. Twenty-four cases of PSF were treated with the FP, and the other 18 cases were treated with the RISN. This study cohort was divided into subgroups according to the AO classification. We retrospectively compared the clinical results between the FP and RISN group.ResultsThere were no significant differences between the two groups in terms of time of clinical union (p = 0.649). In the subgroup analysis, the mean operation time was significantly different only in subgroup A1 (p = 0.03). Complications were seen in 29.2 % (7/24) of patients in the FP group and 27.8 % (5/18) in the RISN group. The age during the index TKA and fracture fixation was a significant risk (p = 0.008) factor for complications between the two groups. No significant differences were found in the other factors between the two groups. The p value for operative time (p = 0.223), immobilization period (p = 0.129), ROM (p = 0.573), KSS (p = 0.379), KSS functional scores (p = 0.310) and time to union (p = 0.649).ConclusionClinical results did not differ according to the treatment methods used. Fixation method and fracture type did not cause an increase in the complication rate, but there was a trend toward higher non-union rates with the FP method and higher re-fracture rate with the RISN method. Noting the fact that only increasing age correlated with an increased complication rate, more careful attention should be paid to elderly patients in terms of both prevention and surgical care.Level of evidence Level III, therapeutic study.

Periprosthetic fractures of the knee: a comprehensive review

“…Additional risk factors include the chronic use of steroid therapy, inflammatory arthropathy such as rheumatoid arthritis, and patients suffering from neurological diseases including epilepsy, Parkinson's disease, poliomyelitis, and myasthenia gravis which all appear to increase the risk of periprosthetic fractures [8,11]. Diabetes mellitus (DM) is an additional risk factor that has an important effect.…”

“…DM may affect the stability of patients and, therefore, contributes to the known risk factor-recurrent falls [12]. It can also affect the post-surgical healing process due to microvascular and neural damage [11]. A further important risk factor that can influence the integrity of the prosthesis is obesity [13].…”

Adverse Events in the Treatment of Periprosthetic Fractures Around the Knee – a Clinical and Radiological Outcome Analysis

“…PpFx der Tibia und der Patella ist der Prävalenz entsprechend gering [10]. Bei allen PpFxK überwog analog zu den Literaturdaten das weibliche Geschlecht [26 -32] [26,27,30,31]. Die Zeit zwischen Index-OP bzw.…”

“…Gondalia et al weisen bei einem jüngeren und gesünderen Kollektiv entsprechend höhere Werte auf [31]. Bezüglich des ROM weichen die Literaturdaten nicht wesentlich von den von uns erhobenen Daten ab [26,27,31].…”

Periprosthetic Distal Femur Fracture after Total Knee Arthroplasty: A Systematic Review

“…Nine articles, totaling 461 fractures, in our study directly compared locked plating and intramedullary nailing. Five articles found no overall advantage to either method, while three articles supported locked plating and one article favored nailing 5,7,13,16,19,20,30,35,41 .…”