Total knee arthroplasty with distal femoral replacement is associated with an important complication rate. A case series

Angers-Goulet, Mathieu; Pelet, Stéphane; Belzile, Étienne L.; Bédard, Martin

doi:10.1016/j.knee.2019.07.013

Cited by 12 publications

(14 citation statements)

References 38 publications

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“…Our finding that 55% of patients required blood transfusions seems high, but at the same level as previously reported (28 and 51%) [ 8 , 11 ]. A tourniquet was not used in any of the cases in our series, in contrast to previous studies [ 2 ], and data from our study cannot recommend for or against the use of a tourniquet in these procedures.…”

Section: Discussioncontrasting

confidence: 93%

“…This study found that distal femoral resection knee arthroplasty appeared to have acceptable patient safety as it was associated with no major in-hospital complications, 17.8% readmission rate in the first 90 days, 8.9% major reoperations, and 2.2% mortality in the first year after surgery. These results are comparable with the results reported from similar studies [ 2 , 11 , 12 ] (Table 4 ).…”

Section: Discussionsupporting

confidence: 92%

“… Readmission rate ≤ 90 days All-cause reop. Rate Mortality ≤ 90 days Mortality ≤ 1 year Current study N = 45 71.3 y I:8.9 II:40 III:51 IV:0 7 days 2% (1) 56% 18% 18% 0 2% Darrith et al 2020 [ 10 ] N = 22 75.8 y – 6 days – – – 14% – – Angers- Goulet et al 2019 [ 2 ] N = 19 79.7 y – – – – – 32% – – Chalmers et al 2020 [ 11 ] N = 34 79.5 y I: 0 II:26 III:71 IV:9 8 days 12% 51% – 7% 0 2% Hoellwarth et al 2018 [ 8 ] N = 53 80.1 y – 6 days – 28% 11% 6% 4% 10% Rajasekaran et al 2020 [ 12 ] N = 24 71.8 y I:0 II: 54.1 III:45.8 IV:0 10 days 29% – – 8% 0% 0% ASA American Society of Anesthesiologists, postop. LOS Postoperative length of hospital stay, Blood trans Blood transfusion, reop reoperation …”

Section: Discussionmentioning

confidence: 99%

“…The number of resection knee arthroplasties performed due to distal femoral fractures and periprosthetic distal femoral fractures appears to be increasing [ 1 , 2 ]. As the number of revision knee arthroplasties is projected to increase dramatically within the next decades, the number of revision cases with severe bone loss will also increase [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Patient safety in distal femoral resection knee arthroplasty for non-tumor indications: a single-center consecutive cohort study of 45 patients

Corap

Brix

Emmeluth

et al. 2022

BMC Musculoskelet Disord

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Background Distal femoral resection knee arthroplasty may be a viable option for several indications other than bone tumors. Resection knee arthroplasty appears to be becoming more common, but patients requiring this type of surgery are often elderly and with high comorbidity. The aim of this study was to report in-hospital complications, readmissions, reoperations, and mortality after distal femoral resection knee arthroplasty for non-tumor indications. Methods We retrospectively identified a consecutive cohort of 45 knees (45 patients) treated with distal femoral resection knee arthroplasty in a single institution between 2012 and 2021. Indications for surgery were failure of osteosynthesis (8), primary fracture treatment (2), periprosthetic fracture (22), and revision arthroplasty with severe bone loss (13). A major reoperation was defined as a major component exchange procedure or amputation. Mean follow-up was 3.9 years. Results The mean age was 71.3 years (SD 12.3), and 64.4% were female; 8.9% were ASA I, 40% ASA II, and 51% ASA III. Median length of stay was 7 days (range 3–19) with no major in-hospital complications, but 55.6% (n = 25) required blood transfusion. The 90-day readmission rate was 17.8% (n = 8), of which 50% was prosthesis-related. Four patients (8.9%) underwent major reoperation due to infection (n = 2), mechanical failure (n = 1), or periprosthetic fracture (n = 1). The mortality rate was 0% ≤ 90 days and 2.2% ≤1 year. Conclusions Distal femoral resection knee arthroplasty in this fragile patient population appears to be a viable and safe option considering that it is a limp salvage procedure most cases.

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Section: Discussioncontrasting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Patient safety in distal femoral resection knee arthroplasty for non-tumor indications: a single-center consecutive cohort study of 45 patients

Corap

Brix

Emmeluth

et al. 2022

BMC Musculoskelet Disord

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“…One was secondary to infection, while the other suffered a peri-prosthetic fracture [6]. This is significantly lower than the 21.1% found to have deep infections in a study assessing complications in patients treated with DFR for various non-oncological reasons rather than just fracture [21]. There have been no documented cases of aseptic loosening of implant components, including those in a three-year follow-up study [9], which is supported by a 100% survivorship documented at four years [21].…”

Section: Discussionmentioning

confidence: 78%

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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A prospective study on outcome of patient-specific cones in revision knee arthroplasty

Cherny

Коваленко

Kulyaba

et al. 2021

Arch Orthop Trauma Surg

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Total knee arthroplasty with distal femoral replacement is associated with an important complication rate. A case series

Cited by 12 publications

References 38 publications

Patient safety in distal femoral resection knee arthroplasty for non-tumor indications: a single-center consecutive cohort study of 45 patients

Patient safety in distal femoral resection knee arthroplasty for non-tumor indications: a single-center consecutive cohort study of 45 patients

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

A prospective study on outcome of patient-specific cones in revision knee arthroplasty

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