Periprosthetic fractures of the distal femur after total knee arthroplasty : Plate versus nail fixation

Wallace, Stephen S.; Bechtold, Daniel; Sassoon, Adam

doi:10.1016/j.otsr.2016.11.018

Cited by 39 publications

(17 citation statements)

References 55 publications

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“…Our study was the rst investigation that ascertained the risk factors of PFF in the early postoperative period within 3 months. In univariate analysis, our signi cant factors, including age, RA, and neurologic disease, were similar to previous studies [3,5,6]. Although several pre-existing neurological diseases, including epilepsy, Parkinson's disease, and poliomyelitis were proposed as the risk factors [9], our study only had Parkinson patients.…”

Section: Discussionsupporting

confidence: 81%

“…Several risk factors have been recognized, which can be arranged into the patient, the surgical, and implant-related factors. Patient factors include advanced age, female gender, rheumatoid arthritis (RA), neurologic diseases, osteoporosis, and chronic steroid use [3,5,6]. While some surgical or technical errors such as anterior femoral notching (AFN) may increase the risk of PFF [1].…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors of Early Periprosthetic Femoral Fracture After Total Knee Arthroplasty

Pornrattanamaneewong

Sitthitheerarut²,

Ruangsomboon

et al. 2021

Preprint

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BackgroundPeriprosthetic femoral fracture (PFF) is a serious complication after total knee arthroplasty (TKA). However, the risk factors of PFF in the early postoperative setting are not well documented. This study determines the risk factors of early PFF after primary TKA.MethodsThis study recruited 24 patients who had early PFF within postoperative 3 months and 96 control patients. Demographic data (age, gender, weight, height, body mass index, Deyo-Charlson comorbidity index, diagnosis, operated side, underlying diseases and history of steroid usage intraoperative outcomes), intraoperative outcomes (operative time, surgical approach, type and brand of the prosthesis), and radiographic outcomes (distal femoral width; DFW, prosthesis-distal femoral width ratio; PDFW ratio, anatomical lateral distal femoral angle; LDFA, femoral component flexion angle; FCFA and anterior femoral notching; AFN) were recorded and compared between groups. Details of PFF, including fracture pattern, preoperative deformity, and time to PFF were also documented.ResultsIn univariate analysis, the PFF group had significantly older, right side injury, rheumatoid, dyslipidemia, Parkinson patients than the control group (p < 0.05). No cruciate-retaining design was used in PFF group (p = 0.004). Differences between the prosthetic brand used were found in this study (p = 0.046). For radiographic outcomes, PFF group had significantly lower DFW but higher PDFW ratio and LDFA than the control group (p < 0.05). While FCFA and AFN were similar between groups. The fracture patterns were medial condylar (45.8%), lateral condylar (25.0%) and supracondylar fracture (29.2%). The mean overall time to PFF was 37.2 ± 20.6 days (range 8 – 87 days). Preoperative deformity was significantly different among the three patterns (p < 0.05). When analyzed using the logistic regression model, age and dyslipidemia were only two independent risk factors for early PFF. The cut-off point of age was > = 75 years, with a sensitivity of 75.0% and specificity of 78.1%. The odds ratio of dyslipidemia was 6.63 (95% confidence interval, 1.11 to 39.8).ConclusionThis study determined that age and dyslipidemia were the independent risk factors for early PFF. However, further well-controlled studies with a larger sample size were needed to address this issue.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Risk Factors of Early Periprosthetic Femoral Fracture After Total Knee Arthroplasty

Pornrattanamaneewong

Sitthitheerarut²,

Ruangsomboon

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Various methods of osteosynthesis have been proposed in surgical treatment strategies, such as single or double plating systems, intramedullary nailing (IM) and rTKA. However, recent reports emphasize that the final outcomes strongly depend on the fracture pattern and localization [ 6 , 8 , 24 ]. A study of periprosthetic tibial fractures found that Felix I fractures are associated with a higher risk of postoperative non-surgical complications, and that those treated with a proximal tibia replacement may cause the development of periprosthetic joint infections [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, every case should be particularly analyzed and the management matched individually. Several methods of treatment, including open reduction and internal fixation (ORIF) with plate and/or nail, and rTKA can be applied [ 7 , 8 , 9 ]. In some rare cases, in patients with loosened prosthesis, the fracture can occur at the level of the femur or the tibial shaft; it can also be found at the top of the prosthesis stem, where it is difficult and technically demanding to achieve stable fracture fixation [ 10 ].…”

Section: Introductionmentioning

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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“…The treatment of patients seeking total knee arthroplasty on both sides is much more ambiguous. The new epidemiological reports estimate that up to 42% of people experiencing knee pain will require surgery on either knee [ 22 ]. Both techniques may be carried out at the same time or one at a time.…”

Section: Introductionmentioning

confidence: 99%

Local Efficacy of Corticosteroids as an Adjuvant for Periarticular Cocktail Injection in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective Randomized Double-Blind Controlled Trial

Peng

Wang

Lin

et al. 2021

Pain Research and Management

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Multimodal cocktail periarticular injections comprising corticosteroids are the most suggested therapy for postoperative discomfort and swelling following total knee arthroplasty (TKA). Nevertheless, previous findings cannot be applied to instances of unilateral total knee arthroplasty on bilateral knees. This randomized, prospective, double-blind, controlled clinical study examines the efficacy as well as safety of periarticular multimodal cocktail injection along or sans corticosteroids in certain situations. The 60 patients (120 knees) that experienced concurrent bilateral total knee arthroplasty were provided periarticular injections along additional betamethasone (7 mg) in the randomized knee, as well as the other knee, where corticosteroid was not administered. Key results were “pain scores at rest as well as in action” on a visual analogue scale of 11 pt. Other results included motion range, swelling of the thigh, Hospital for Special Surgery score (HSS score), and adverse effects were measured between the two sides. No statistically promising variations were found in the visual analogue scale ranking, motion range, girth of the thigh, and HSS score, as well as complications between the two sides. The impact on treatment outcomes was maintained between the knees on postoperative day 3 or at 3 months of follow-up. Multimodal periarticular injection without corticosteroid will alleviate postoperative swelling and pain. More studies are needed for the use of betamethasone as a corticosteroid in periarticular multimodal cocktail injections. This Chinese Clinical Trial Registry is registered with ChiCTR-OPC-17013503, dated 2017-11-23, available from http://www.chictr.org.cn/showproj.aspxproj=23146.

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Periprosthetic fractures of the distal femur after total knee arthroplasty : Plate versus nail fixation

Abstract: 4.

Cited by 39 publications

References 55 publications

Risk Factors of Early Periprosthetic Femoral Fracture After Total Knee Arthroplasty

Risk Factors of Early Periprosthetic Femoral Fracture After Total Knee Arthroplasty

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

Local Efficacy of Corticosteroids as an Adjuvant for Periarticular Cocktail Injection in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective Randomized Double-Blind Controlled Trial

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