Supracondylar Distal Femoral Nonunions Treated With a Megaprosthesis in Elderly Patients: A Report of Two Cases

Abstract

The purpose of this paper is to report the use of total knee arthroplasty, a megaprosthesis, as a treatment in elderly patients who have a persistent nonunion of a supracondylar femur fracture. This case report includes two elderly patients who sustained supracondylar femur fractures that failed to unite with standard operative fixation methods. Despite multiple procedures during a long period, patients had a persistent nonunion. Both patients underwent total arthroplasty with a cemented kinematic rotating hinge and had significant clinical improvement. The Hospital for Special Surgery (HSS) knee scores increased from fifty-four points to seventy points in one patient and forty-two points to seventy-three points after surgery in the other patient. Both patients had excellent range of motion after surgery. A cemented megaprosthesis appears to be a viable treatment option for persistent nonunions of supracondylar femur fractures in elderly patients. It is well tolerated and permits early ambulation and return to activities of daily living.

Addition of a Medial Locking Plate to an In Situ Lateral Locking Plate Results in Healing of Distal Femoral Nonunions

“…These injuries frequently show bone loss and extensive soft tissue scarring [5]. Many treatment options have been described in the literature including external fixation, arthroplasty, retrograde intramedullary nailing, and ORIF with lateral fixed angle plating [2,4,8,10,11,15,16,21]. We initiated the use of medial stabilization plating, grafting, and revision of lateral plating as needed in 2007 because we frequently observed motion at distal femoral nonunion sites with varus/valgus stress (using fluoroscopy and direct observation at the nonunion site).…”

“…However, the Ilizarov method has a steep learning curve and requires strict patient compliance with frequent followups [4,17]. Several case series using arthroplasty to reconstruct distal femoral nonunion have shown a high proportion of patients achieve good pain relief and return to ambulation, suggesting this technique may be appropriate as a salvage procedure in elderly patients [8,10,16]. Results of retrograde nailing for distal femoral nonunion historically have been poor.…”

Length of Endoprosthetic Reconstruction in Revision Knee Arthroplasty Is Associated With Complications and Reoperations

“…An endoprosthesis is an effective alternative to structural allograft reconstruction for revision TKA in the setting of severe femoral bone loss. The relative ease of insertion and early mobility it affords are attractive benefits, especially for older and frailer individuals [5,9,10].…”

Constraints in total knee arthroplasty: current status and review of literature

“…[13][14][15][16] It is also considered utilitarian for extensor mechanism incompetency, distal femoral or proximal tibial defect resulting from a tumour lesion or mechanical problem, or a comminuted fracture or malunion of the distal femur in the elderly subjects. 17,18 Neuropathic joints, elderly people with poor soft tissue envelope are relative indications for their use. There is no denying the fact that RHK prosthesis provides the surgeon an indispensable tool for salvage of revision TKA.…”