Distal femoral arthroplasty for native knee fractures

Abstract

Aims The aim of this study was to investigate the rate of revision for distal femoral arthroplasty (DFA) performed as a primary procedure for native knee fractures using data from the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR). Methods Data from the AOANJRR were obtained for DFA performed as primary procedures for native knee fractures from 1 September 1999 to 31 December 2020. Pathological fractures and revision for failed internal fixation were excluded. The five prostheses identified were the Global Modular Arthroplasty System, the Modular Arthroplasty System, the Modular Universal Tumour And Revision System, the Orthopaedic Salvage System, and the Segmental System. Patient demographic data (age, sex, and American Society of Anesthesiologists grade) were obtained, where available. Kaplan-Meier estimates of survival were used to determine the rate of revision, and the reasons for revision and mortality data were examined. Results The AOANJRR identified 153 primary DFAs performed for native knee fractures in 151 patients during the study period, with 63.3% of these (n = 97) performed within the last five years. The median follow-up was 2.1 years (interquartile range 0.8 to 4.4). The patient population was 84.8% female (n = 128), with a mean age of 76.1 years (SD 11.9). The cumulative percent revision rate at three years was 10%. The most common reason for revision was loosening, followed by infection. Patient survival at one year was 87.5%, decreasing to 72.8% at three years postoperatively. Conclusion The use of DFA to treat native knee fractures is increasing, with 63.3% of cases performed within the last five years. While long-term data are not available, the results of this study suggest that DFA may be a reasonable option for elderly patients with native knee fractures where fixation is not feasible, or for whom prolonged non-weightbearing may be detrimental. Cite this article: Bone Joint J 2022;104-B(7):894–901.

Surgical approaches to periprosthetic femoral fractures for plate fixation or revision arthroplasty

“…5 In contrast, infection rates of up to 10% have been reported following the use of femoral endoprostheses for fracture. 26 One-year mortality rates have been favourable, at 16% for periprosthetic fractures around the hip and 13% for those around the knee. 4,5…”

“…5 In contrast, infection rates of up to 10% have been reported following the use of femoral endoprostheses for fracture. 26 One-year mortality rates have been favourable, at 16% for periprosthetic fractures around the hip and 13% for those around the knee. 4,5 In summary, these approaches can be used to expose the full length of the femur for the management of periprosthetic and interprosthetic fractures with plate fixation or revision arthroplasty.…”

High revision rates and mortality after distal femoral replacement for periprosthetic distal femoral fractures: analysis from the German Arthroplasty Registry (EPRD)

“…In the studies included by Rubinger et al [ 14 ] reoperation rates ranged from 0 to 45%. Recent analysis from the AOANJRR reported revision rates of 12% for DFR in PDFF after 6 years [ 16 ] and 12% after 4 years in native knee fractures [ 17 ]. As in the AOANJRR, this study showed no significant difference between cemented and cementless stem fixation which might be caused by the low number of cementless DFR.…”

“…All four meta-analyses acknowledged the limited data, a high risk of bias and recommended further studies. Recently, two analyses from the Australian Joint Replacement Registry (AOANJRR) reported about DFR in PDFF [ 16 ] and native knee fractures [ 17 ]. Despite being one of the oldest Arthroplasty registry, the number of cases for analysis was limited.…”

75 years young

“…It is always reassuring to read reflections from those heavily involved in the analysis of registry data about its advantages, disadvantages, value moving forward, and in particular, how it could be improved. [8][9][10][11][12][13][14][15][16][17][18][19][20] We also broach optimal management in acute trauma with an excellent annotation from Vallier, 21 which will hopefully give insight and stimulate debate.…”