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

Abstract

This study was designed to itemize and analyze the classification of fracture types and their corresponding outcomes in an attempt to provide a better understanding of the current treatment methods. Two PubMed searches were performed using the words "periprosthetic distal femur fracture" and "periprosthetic supracondylar femur fracture" in studies that were published in the previous 10 years (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014). Data from 41 articlesthat met the general inclusion criteria, were collected and categorized into fracture type and treatment method groupings. Healing outcome and complications were the two parameters used to analyze the data. Treatment techniques were grouped in the following categories: locking plate, non-locking plate, intramedullary nail/rod, screw, blade plate, cerclage wires, allograft, external fixation, revision arthroplasty, non-operative, and other. Classification systems by Lewis and Rorabeck, the Association for Osteosynthesis/Orthopedic Trauma Association (AO/OTA), Su et al., Neer et al., Kim et al., Backstein et al., and the Société Française de Chirurgie Orthopédique et Traumatologique were reported. In total 448 fractures were identified, of which Rorabeck type II was the most common fracture studied. The two most successful treatment options for periprosthetic distal femur fractures were locking plate (87%) and intramedullary nail/rod (84%). The most frequent complications associated with periprosthetic distal femur fractures included non/mal/delayed union and the need for revision. Locking plates used to treat Rorabeck type II fractures had a complication rate of 35% and those treated with intramedullary nailing had a higher complication rate of 53%. In conclusion, the most frequent type of periprosthetic distal femur fracture after total knee arthroplasty was Rorabeck type II. The most common treatments for these types of fractures are locked plating and intramedullary nailing, with similar healing rates of 87% and 84%, respectively. However, the complication rate for locked plating was lower than for intramedullary nailing.

Total diz artroplastisi ile ilişkili periprostetik kırıklar

“…[2] Çivinin redüksiyon stabilitesi, kırığın distal parçasındaki kilitleme vidalarına bağlıdır, bu nedenle, en az iki bikortikal vida gereklidir ve protezin anterior-superior ucunun distaline yerleşmiş kırıklar, genellikle çiviyle zayıf bir stabilizasyon sağlar ve kaynamama riski daha yüksektir. [36] Şiddetli osteoporoz durumunda, kilitli plaklar çivilemeye göre daha kararlı bir tespit sağlar. [14] Son olarak; retrograd çivileme, iki implant arası stres oluşturarak yeni kırıklara yol açma potansiyeli bulunduğundan, proksimal IM implantlı veya kalça artroplastisi olan hastalarda kontrendikedir.…”

“…Kilitli plaklama ve retrograd çivilemeyi karşılaştıran çalışmalar, ameliyat süresi, fonksiyonel iyileşme, tam yük verme zamanı, KSS (Knee Society Score) ve kaynama zamanı açısından anlamlı farklılık olmadığını bildirmektedir. [36] Fakat, yanlış kaynama oranlarında kilitli plakların daha iyi olduğu istatiksel olarak anlamlı bildirilmiştir. [39] Ayrıca son yıllarda bir kısım yazar, özellikle Su, Tip III gibi distal yerleşimli olan, osteoporotik hastalarda oluşan ve mediyal korteks desteği kaybolmuş kırıklarda çift taraflı kilitli plak kullanımını önermiştir (Şekil 1 ve 2).…”

“…[32] En sık rastlanan iki komplikasyon kaynama problemleri ve revizyon olup, revizyon genellikle yanlış kaynama veya kaynamamayı takip ettiği için, bu anlaşılabilir bir durumdur. [36] Adduktor ve gastroknemius kas gruplarının uyguladığı kuvvetler sonucu varus, fleksiyon ve internal rotasyon deformiteleri ile görülen malunion oranları yaygındır. [48] gerçekleştirilememesi durumunda ameliyathanede her zaman alternatif tedavi stratejileri hazır olmalıdır.…”

Effectiveness of circular external fixator in periprosthetic fractures around the knee

“…increasing number of TJAs performed annually and the growing elderly population. With an increase in the number of elderly patients with osteoporosis, artificial femoral head replacement (FHR) is also emerging as a simple procedure for femoral neck fractures [1,2]. Furthermore, because total hip arthroplasty (THA) and total knee arthroplasty (TKA) generally result in prolonged use of the artificial joint, the incidence of periprosthetic fracture also increases in elderly patients after TJA and FHR.…”

Effectiveness of circular external fixator in periprosthetic fractures around the knee

“…increasing number of TJAs performed annually and the growing elderly population. With an increase in the number of elderly patients with osteoporosis, artificial femoral head replacement (FHR) is also emerging as a simple procedure for femoral neck fractures [1,2]. Furthermore, because total hip arthroplasty (THA) and total knee arthroplasty (TKA) generally result in prolonged use of the artificial joint, the incidence of periprosthetic fracture also increases in elderly patients after TJA and FHR.…”