The Treatment of Periprosthetic Distal Femoral Fractures After Total Knee Replacement

Quinzi, David A; Childs, Sean; Lipof, Jason S; Soin, Sandeep; Ricciardi, Benjamin F.

doi:10.2106/jbjs.rvw.20.00003

Cited by 19 publications

(17 citation statements)

References 71 publications

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“…Their analysis, based on the French Society of Orthopedic Surgery and Traumatology (SoFCOT) classification [ 26 ], concluded that type B (fracture contact with keel or stem) has an especially poor prognosis. Periprosthetic femur fractures have been associated with substantial morbidity and mortality, regardless of fixation technique [ 27 ]. However, no consensus exists on whether plating or IM is a superior method of internal fixation.…”

Section: Discussionmentioning

confidence: 99%

Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation

Grzelecki

Marczak

Kwolek

et al. 2021

JCM

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The aim of this study was to evaluate the bone union, complication rate, clinical and functional outcomes of long-stemmed total knee arthroplasty (TKA) in patients with periprosthetic femoral or tibial shaft fractures and in patients with femoral or tibial shaft fractures with coexisting advanced knee osteoarthritis (OA). This retrospective study comprised 25 patients who underwent surgery due to tibial or femoral shaft fractures: (1) with coexisting severe knee OA or (2) with a periprosthetic fracture requiring implant exchange. In all cases, fracture stabilization was performed intramedullary with the use of long-stemmed implants without the use of additional fixation material (plates, screws, or cerclage). Bone union was achieved in 22/25 patients (88%). One patient required revision with additional plate stabilization due to non-union, and asymptomatic partial bone union was observed in two cases. The group with periprosthetic fractures demonstrated good clinical (mean 73.1 ± 13.3) and moderate functional (mean 59.2 ± 18.8) outcomes in the Knee Society Scoring system (KSS). In the group with shaft fracture and coexisting OA significantly higher clinical (excellent results, mean 84.1 ± 11; p = 0.03) and functional (good results, mean 76.2 ± 20.6; p = 0.04) results were noted. There were no statistically significant differences in terms of range of motion (ROM) or complication rate between these two groups. One-stage TKA with a long-stemmed implant without the use of additional fixation material is an effective method for the treatment of femoral or tibial shaft fractures in patients who require joint replacement. Despite being technically demanding, the approach yields bone union and moderate to excellent clinical and functional outcomes with a relatively low complication rate.

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Section: Discussionmentioning

confidence: 99%

Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation

Grzelecki

Marczak

Kwolek

et al. 2021

JCM

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“…Supracondylar periprosthetic femoral fractures occur usually in geriatric populations [ 2 ] due to low velocity traumas such as a fall from standing height [ 3 ]. Osteoporotic and osteopenic bone is the major risk factors for such injuries [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…These fractures generally occur in the geriatric population aged above 60 years with associated osteopenic or osteoporotic bone quality [ 2 ]. Commonly, the fracture is secondary to minimal low-velocity trauma [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Management of a Complex Supracondylar Periprosthetic Femur Fracture with Intramedullary Strut Allograft and Bilateral Locking Plates

Moukarzel

Aouad

Daher

et al. 2021

Case Reports in Orthopedics

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Supracondylar periprosthetic femoral fractures occurring above total knee replacements have been considered a rare entity. However, they continue to increase in frequency with the increasing number of arthroplasties and the improvement in morbidity and mortality in the concerned patient population. The management of periprosthetic distal femoral fractures is a challenging orthopedic problem. In this brief communication, a case of 49-year-old woman with rheumatoid arthritis who sustained a low distal comminuted periprosthetic femoral fracture is presented. Her fracture was eventually managed with an intramedullary fibular strut allograft and bilateral locking plate placement reaching satisfactory healing and restoration of alignment. The primary aim of this report is to provide insight into this novel technique as a successful alternative to other standard surgical options.

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“…However, the balance between bone formation and bone resorption in osteoporotic patients is disrupted, thus resulting in poor osseointegration after prosthesis implantation ( Toepfer et al, 2021 ). So far, various conventional treatments have been attempted to increase the osseointegration of osteoporosis patients after joint replacement, but these treatments have not alleviated the problem ( Monotti et al, 2020 ; Quinzi et al, 2020 ). Postoperative systemic administration of antiresorptive drugs is limited by various side effects and low bioavailability that consistently achieves an unsatisfactory local osseointegration effect ( Frank et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Incorporation of Bone Morphogenetic Protein-2 and Osteoprotegerin in 3D-Printed Ti6Al4V Scaffolds Enhances Osseointegration Under Osteoporotic Conditions

Wang

et al. 2021

Front. Bioeng. Biotechnol.

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Osteoporosis is an age-related metabolic disease that results in limited bone regeneration capacity and excessive osteoclast activity. After arthroplasty in patients with osteoporosis, poor interface osseointegration resulting from insufficient bone regeneration ability often leads to catastrophic complications such as prosthesis displacement and loosening and periprosthetic fractures. In this study, we prepared a thermosensitive hydrogel loaded with bone morphogenetic protein-2 (BMP-2) to promote osteogenesis and osteoprotegerin (OPG) to inhibit excessive osteoclast activity. To construct three-dimensional (3D)-printed composite scaffolds for implantation, a hydrogel loaded with drugs was injected into porous Ti6Al4V scaffolds. The 3D-printed composite scaffolds showed good biocompatibility and sustained release of BMP-2 and OPG for more than 20 days. In vitro experiments indicated that composite scaffolds promoted osteogenic differentiation and reduced the osteoclastic activation simultaneously. Remarkably, immunofluorescence staining, micro-CT, histological, and biomechanical tests demonstrated that the sustained release of both BMP-2 and OPG from composite scaffolds significantly improved bone ingrowth and osseointegration in osteoporotic defects. In conclusion, this study demonstrated that the BMP-2- and OPG-loaded 3D-printed composite scaffolds can potentially promote osseointegration for osteoporotic patients after joint replacement.

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The Treatment of Periprosthetic Distal Femoral Fractures After Total Knee Replacement

Cited by 19 publications

References 71 publications

Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation

Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation

Management of a Complex Supracondylar Periprosthetic Femur Fracture with Intramedullary Strut Allograft and Bilateral Locking Plates

Incorporation of Bone Morphogenetic Protein-2 and Osteoprotegerin in 3D-Printed Ti6Al4V Scaffolds Enhances Osseointegration Under Osteoporotic Conditions

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