Purpose:We assessed and compared the clinical and radiologic outcomes of treatment in periprosthetic fractures of the femur after total knee arthroplasty. Materials and Methods: We compared 22 knees, 22 patients of femoral periprosthetic fractures which had been fixed with absolute stabilization such as plate or screw fixation in 16 cases (group A), and with relative stabilization such as retrograde intramedullary nailing or Ender nailing in six cases (group B) from November 2004 to March 2013; the mean follow-up period was 51.9 months. Results: The mean tibio femoral angle and the mean mechanical axis showed statistically significant change in group B, between before fracture and last follow-up. The mean bone union time and the mean hospital for special surgery score were not significantly different between group A and B. Nonunion was demonstrated in one case in each group, malunion was demonstrated in one case in group B. Conclusion: In the treatment of periprosthetic fractures of the femur after total knee arthroplasty, absolute stabilization had an advantage for regain of limb alignment. Among the complications, more cases of refracture and infection were observed in the absolute stabilization group, while more cases of nonunion and malunion were observed in the relative stabilization group.

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Purpose A modified technique, medial indentation of the medial collateral ligament(MCL),was usedin total kneearthroplastywith severe type II valgus deformity. The study compared the clinical outcomes of the technique relative to conventional release group. Methods Consecutive patients with a Krackow type II valgus deformity of >20° who underwent a primary unilateral TKA between May 2008 and June 2017 were retrospectively studied. Modified MCL indentation technique was performed in 20 patients (group A), while the remaining 23 patients (group B) received routine release technique. Radiological parameters, such as the valgus angle (VA), and functional outcomes including the use of constraint implants, Knee Society Score(KSS), Knee Society function score(KSF), and height of the polyethylene insert, were compared between the two groups.Results 43 consecutive patients had a minimum 2-year follow-up. The preoperative VA was comparable between group A (23.5° ± 5.8°) and group B (21.3° ± 3.2°, P =0.134), so was the postoperative VA (1.1° ± 2.1° and 2.5° ± 3.0°, P =0.084 in groups A and B, respectively).The postoperative KSS and KSF showed marked improvement. While no statistically significant difference in preoperative or postoperative functional scores was found between two groups, group A had thinner PE insert (9.5 ± 1.1 mm vs. 12.9 ± 1.5 mm) and less use of constrained condylar inserts(15% vs. 69.6%). Conclusion Modified MCL indentation technique can achieve good outcomes in TKA with type II valgus deformity of >20°.