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Hill ZP, Brown JR, DeGenova D, Taylor BC, Mendicino R, Korb I. Traumatic Periprosthetic Fractures Following Total Ankle Replacement: A Systematic Review and Proposed Classification. Foot Ankle Spec 2025; 18:295-304. [PMID: 39310975 DOI: 10.1177/19386400241280357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2025]
Abstract
Total ankle replacements (TAR) are increasingly utilized, but postoperative traumatic periprosthetic fractures remain a rare yet challenging complication. This systematic review aims to address the gap in literature by proposing a comprehensive classification system for these fractures, considering implant stability, fracture location, and surrounding bone quality. A systematic review identified 13 cases from 9 studies meeting inclusion criteria. Fractures were categorized using the proposed Hill-Brown classification: Type A (talus or fibula), Type B (distal tibial component), and Type C (diaphysis/proximal tibial metaphysis). Implant stability was a key factor, with Type B fractures further classified as B1 (stable), B2 (unstable with adequate bone stock), and B3 (unstable with poor bone stock). Most fractures occurred at or near the distal tibial component (Type B), with implant stability largely dependent on fracture location and bone quality. Surgical fixation, particularly minimally invasive plate osteosynthesis (MIPO) with locking plates, was the preferred treatment for stable implants, showing low complication rates. Unstable implants often required revision TAR or conversion to arthrodesis. Surgical intervention is recommended following all traumatic periprosthetic fractures in the setting of a TAR. Bone quality, particularly in patients with rheumatoid arthritis or osteoporosis, significantly impacted treatment decisions. Our findings emphasize the importance of fracture location, implant stability, and bone quality in managing these fractures. Future multicenter studies are necessary to validate this classification system and refine treatment protocols.Level of Evidence: Level III.
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Affiliation(s)
- Zachary P Hill
- Grant Medical Center Foot and Ankle Surgery, OhioHealth, Columbus, Ohio
| | - Joseph R Brown
- Grant Medical Center Foot and Ankle Surgery, OhioHealth, Columbus, Ohio
| | - Daniel DeGenova
- Department of Doctors Hospital Orthopedic Surgery, OhioHealth, Columbus, Ohio
| | - Benjamin C Taylor
- Grant Medical Center Orthopedic Trauma and Reconstructive Surgery Department, OhioHealth, Columbus, Ohio
| | - Robert Mendicino
- Foot and Ankle Reconstructive Surgery, Department of Orthopedic, St. Clair Health, Pittsburgh, Pennsylvania
| | - Isaac Korb
- The Ohio State University, Columbus, Ohio
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Pitsilos C, Konstantinidis CI, Edery EG, Karditsas KZ, Kanakaris NK, Giannoudis PV. Treatment of Interprosthetic Femoral Fracture Nonunion: A Systematic Review. J Arthroplasty 2025:S0883-5403(25)00532-7. [PMID: 40383168 DOI: 10.1016/j.arth.2025.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2025] [Revised: 05/09/2025] [Accepted: 05/09/2025] [Indexed: 05/20/2025] Open
Abstract
BACKGROUND Interprosthetic fractures (IFs) of the femur present complex injuries associated with increased morbidity and mortality. Limited bone stock between the proximal and distal prostheses makes fracture reduction and stabilization challenging. Nonunion is a common and severe complication of IFs, often requiring multiple interventions. This systematic review aimed to identify the most successful treatment for femoral IFs and determine the overall incidence and best management strategies for IF nonunion. METHODS There were five electronic databases (Medline/PubMed, Scopus, Web of Science, Cochrane and EMBASE) searched for relevant studies published until July 2024. There were 35 studies that fulfilled the inclusion criteria. RESULTS A total of 503 patients who had 506 IFs were analyzed. The mean age was 79 years (range, 30 to 98), and 83.6% were women. The one-year mortality was 9.9% (range, 0 to 66.7). In terms of fixation options, increased frequency of nonunion was found after nonoperative treatment (50%) and retrograde intramedullary nailing (RIN) (11.1%), while after the combination of open reduction and internal fixation (ORIF) with RIN, nonunion was not observed. In the subgroup analysis of patients treated with ORIF, dynamic condylar screws (33.3%) and conventional plates (27.3%) were related to increased frequency of nonunion compared to locking compression plates (9.1%), while double plating was the most successful method (nonunion was not reported). The overall nonunion rate was 9.5%. Depending on treatment modality, the incidence of nonunion was 8.7% after ORIF and 5.5% after revision arthroplasty combined with ORIF. For the treatment of nonunion, no secondary nonunion was reported after ORIF + RIN and double plating. CONCLUSION For the treatment of IFs, non-locking plating and RIN were associated with higher nonunion rates, whereas double plating and ORIF + RIN were the most successful treatment options. Interprosthetic fracture nonunion was reported in 9.5% of cases, but further research is warranted to determine the most successful management approach.
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Affiliation(s)
- Charalampos Pitsilos
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom.
| | - Christos I Konstantinidis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
| | | | | | - Nikolaos K Kanakaris
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom
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Sato S, Hatashita S, Hakozaki M, Kameda T, Kaneuchi Y, Ito M, Matsumoto Y. Whole Span Plating Prevents Subsequent Ipsilateral Femoral Fractures After Peri-Implant Fixation: A Preliminary Report. J Clin Med 2025; 14:3473. [PMID: 40429467 PMCID: PMC12112543 DOI: 10.3390/jcm14103473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2025] [Revised: 05/12/2025] [Accepted: 05/14/2025] [Indexed: 05/29/2025] Open
Abstract
Background: Peri-implant femoral fractures are increasingly prevalent among the elderly, often leading to re-fractures due to osteoporosis and implant stress. Whole span plating (WSP) has been proposed as a surgical approach to mitigate this risk. Methods: A retrospective study was conducted on 10 patients (mean age: 79.5 years) who underwent WSP for peri-implant femoral fractures between April 2020 and March 2023. Fractures were classified using the Vancouver, NPPIF, and Lewis and Rorabeck systems. Surgical indication required meeting at least two of the following criteria: age ≥ 70 years, history of fragility fracture(s), high fall risk, severe osteoporosis, extensive fracture pattern, or no implant loosening. Results: No re-fractures were observed during a mean follow-up period of 14.5 months. Although 90% of patients required red blood cell transfusions (mean volume: 3.8 units), early weight-bearing was achieved in most cases. Four patients had received osteoporosis treatment, highlighting the need for integrated bone health management. Conclusions: WSP appears to be a feasible and safe surgical option for high-risk patients with peri-implant femoral fractures, potentially reducing the incidence of subsequent fractures. Further studies with larger cohorts and longer follow-up are warranted.
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Affiliation(s)
- Shunsuke Sato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan; (M.H.); (T.K.); (Y.K.); (Y.M.)
- Department of Traumatology and Reconstructive Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan; (S.H.); (M.I.)
| | - Satoshi Hatashita
- Department of Traumatology and Reconstructive Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan; (S.H.); (M.I.)
- Traumatology and Reconstructive Surgery Center, Aizu Chuo Hospital, Fukushima 965-0011, Japan
| | - Michiyuki Hakozaki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan; (M.H.); (T.K.); (Y.K.); (Y.M.)
| | - Takuya Kameda
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan; (M.H.); (T.K.); (Y.K.); (Y.M.)
| | - Yoichi Kaneuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan; (M.H.); (T.K.); (Y.K.); (Y.M.)
| | - Masayuki Ito
- Department of Traumatology and Reconstructive Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan; (S.H.); (M.I.)
- Traumatology and Reconstructive Surgery Center, Aizu Chuo Hospital, Fukushima 965-0011, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan; (M.H.); (T.K.); (Y.K.); (Y.M.)
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Jankowski JM, Zapf CG, Hong IS, Miceli JG, Yoon RS, Liporace FA. Nail plate combination technique for periprosthetic supracondylar femur fractures: How far have we come? J Clin Orthop Trauma 2025; 64:102969. [PMID: 40160378 PMCID: PMC11951993 DOI: 10.1016/j.jcot.2025.102969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/10/2025] [Accepted: 03/06/2025] [Indexed: 04/02/2025] Open
Abstract
Open reduction and internal fixation for periprosthetic supracondylar femur fractures (PPFx) around a stable total knee arthroplasty (TKA) remains the gold standard, with the nail plate combination (NPC) technique offering increased biomechanical stability and high union rates. Advances in implant technology, particularly the introduction of the novel lateral locking attachment washer (LAW), have increased the availability of NPC options in the treatment of these technically demanding and complex cases. In this technical paper, we discuss two cases: Case 1 - describing the traditional NPC technique utilizing a retrograde intramedullary nail and lateral distal femoral locking plate; Case 2 - describing the NPC technique utilizing a retrograde nail and a novel LAW implant, which is now the authors' more commonly utilized technique. Managing PPFx around a TKA implant remain a challenge, however, the integration of the LAW and newer generation of retrograde intramedullary nails have marked significant progress in treating these complex fractures.
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Affiliation(s)
- Jaclyn M. Jankowski
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center, Jersey City Medical Center, RWJBarnabas Health Livingston, Jersey City, NJ, United States
| | - Christian G. Zapf
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center, Jersey City Medical Center, RWJBarnabas Health Livingston, Jersey City, NJ, United States
| | - Ian S. Hong
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center, Jersey City Medical Center, RWJBarnabas Health Livingston, Jersey City, NJ, United States
| | - Joseph G. Miceli
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center, Jersey City Medical Center, RWJBarnabas Health Livingston, Jersey City, NJ, United States
| | - Richard S. Yoon
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center, Jersey City Medical Center, RWJBarnabas Health Livingston, Jersey City, NJ, United States
| | - Frank A. Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center, Jersey City Medical Center, RWJBarnabas Health Livingston, Jersey City, NJ, United States
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Kalyan K, Singh A, Kumar P, Gundalli AC, Mane SS, Swarnkar H, Singh L. Robotic total knee arthroplasty for moderate to high-grade valgus knee deformity: technique and outcomes. SICOT J 2025; 11:12. [PMID: 40035462 DOI: 10.1051/sicotj/2025005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 02/02/2025] [Indexed: 03/05/2025] Open
Abstract
INTRODUCTION Although the surgical techniques and functional outcomes of conventional total knee arthroplasty (TKA) are well-established, there is limited data available on robotic arm-assisted TKA (RATKA) in the context of valgus knee arthroplasty. The purpose of this study is to assess the efficacy of RATKA in the correction of moderate to severe valgus knee deformities using minimally constrained implants and to evaluate the short-term functional outcomes associated with this technique. METHODS This prospective study was conducted on patients with moderate to severe grade valgus knee deformity who underwent RATKA from August 1, 2020 to May 31, 2022. Of 873 primary RATKA cases, 48 cases had valgus knee deformities. Among these, 27 had grade 2-3 valgus with intact medial collateral ligament (MCL), two had grade 3 valgus with incompetent MCL, 14 had grade 1 valgus, and five had post-traumatic valgus deformities. Over a two-year follow-up period, functional outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS), and complications were documented; however, radiological outcomes were not analyzed. RESULTS Among 27 patients with Grade 2-3 valgus, the final cohort included 21 patients (24 knees). The mean age was 58.33 ± 9.63 years and 70.8% were female. Ten (41.7%) patients had rheumatoid arthritis and 14 (58.3%) had degenerative osteoarthritis (OA). The median surgical time was 68.00 (13.00) minutes, and the median blood loss was 478.45 (176.25) mL. The valgus grade was reduced from a baseline value of 22.43 ± 7.05 degrees to 5.26 ± 1.53 degrees at 6 weeks. The WOMAC scores improved from 67.58 ± 7.27 at baseline to 1.38 ± 0.57 in the second year post-operatively. Similarly, the KSS scores improved from 26.67 ± 10.34 at baseline to 181.96 ± 7.20 in the second year. One patient sustained a Type II supracondylar femur fracture after a fall, managed with distal femur arthroplasty, while another had delayed tibia pin tract healing, treated with antibiotics and dressings. CONCLUSION RATKA facilitates precise correction of moderate to severe valgus deformity through enhanced surgical planning and execution, achieving adequate functional outcomes with minimal complications through the application of functional alignment philosophy.
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Affiliation(s)
- Kanukuntla Kalyan
- Anup Institute of Orthopaedics & Rehabilitation, G75-77, PC Colony, Kankarbagh, Patna, Bihar 800020, India
| | - Ashish Singh
- Anup Institute of Orthopaedics & Rehabilitation, G75-77, PC Colony, Kankarbagh, Patna, Bihar 800020, India
| | - Purushotam Kumar
- Anup Institute of Orthopaedics & Rehabilitation, G75-77, PC Colony, Kankarbagh, Patna, Bihar 800020, India
| | | | - Sudhir Shankar Mane
- Anup Institute of Orthopaedics & Rehabilitation, G75-77, PC Colony, Kankarbagh, Patna, Bihar 800020, India
| | - Himanshu Swarnkar
- Anup Institute of Orthopaedics & Rehabilitation, G75-77, PC Colony, Kankarbagh, Patna, Bihar 800020, India
| | - Lavanya Singh
- The Hazeley Academy, Emperor Dr, Hazeley, Milton Keynes MK8 0PT, United Kingdom
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Trikha V, Kumar A. Osteoporotic Distal Femur Fractures: An Overview. Indian J Orthop 2025; 59:311-325. [PMID: 40201919 PMCID: PMC11973033 DOI: 10.1007/s43465-025-01345-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 01/23/2025] [Indexed: 04/10/2025]
Abstract
Background Distal femur fractures in geriatric patients present a significant challenge due to age-related factors, including osteoporosis, comorbidities, and diminished functional reserve. These injuries have high morbidity and require nuanced management strategies to optimize outcomes. In the current chapter, we have reviewed the challenges associated with these intricate injuries and the potential solutions for their favorable outcomes. Method We reviewed the published literature on epidemiology, pathophysiology, clinical presentation, and current treatment modalities for distal femur fractures in the elderly population, with a focus on advances in surgical techniques, rehabilitation strategies, and outcomes. Discussion Operative treatment remains the mainstay, tailored to fracture patterns, patient comorbidities, and bone quality. Locking plates offer strong fixation in osteoporotic bone, while intramedullary nails, especially the newer generation ones, provide better biomechanical stability for unstable fracture types. Total knee replacement and distal femur replacement is a viable option in severe cases with comminution or poor bone quality. Conclusion Distal femur fractures in the elderly are complex injuries with high morbidity and mortality. Early surgical intervention, optimized postoperative care, and a focus on addressing osteoporosis are key to improving outcomes and minimizing the long-term impact of these fractures on the vulnerable population. Favorable fracture healing can be achieved with plates, nails and their combinations as long as they are judiciously used.
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Affiliation(s)
- Vivek Trikha
- JPNATC, AIIMS, Room #406, Fourth Floor, New Delhi, India
| | - Arvind Kumar
- JPNATC, AIIMS, Room #406, Fourth Floor, New Delhi, India
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Garabano G, Rodriguez JA, Perez Alamino L, Del Sel H, Pesciallo CA. Functional and radiological outcomes of total knee arthroplasty using posterior-stabilized U2 knee system: A retrospective study in 560 cases at five years of follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3939-3945. [PMID: 39217231 DOI: 10.1007/s00590-024-04082-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE The purpose of this study was to assess clinical and functional outcomes as well as the prosthesis survival rates of the U2 Knee system in primary total knee arthroplasty (TKA) with a minimum follow-up of four years. METHODS We retrospectively analyzed 560 consecutively primary TKA performed between 2015 and 2019 due to osteoarthritis with a mean follow-up of 5.4 ± 1.1 years. The clinical outcomes were assessed using the knee society score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic outcomes were assessed using the American knee society's roentgenographic evaluation system. Prosthetic survival was calculated using the Kaplan-Meier method. RESULTS Postoperative KSS showed significant improvement at one year (Clinical: 37.4 ± 4.1 vs. 91.9 ± 3.7; p < 0.01; Functional: 41.2 ± 3.3 vs. 90.6 ± 4.8; p = < 0.01), with these improvements maintained throughout the follow-up period. The WOMAC score improved from 60 ± 10.1 preoperatively to 10.9 ± 8.3 (p = 0.02) at the end of the follow-up. There were 20 (3.7%) knees with radiolucent lines around the implant (< 2 mm), and none showed evidence of loosening. There were six (1.1%) revisions-four due to prosthetic joint infections and two due to periprosthetic femur fracture. The prosthetic survival was 97.8% at the study closure. CONCLUSION The U2 knee system demonstrates effective and safe performance for primary TKA with significant improvements in functional scores, patient-reported outcomes, and a promising prosthesis survival rate at mid-term follow-up. We will continue with the series analysis to assess the long-term outcomes.
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Affiliation(s)
- Germán Garabano
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
| | - Joaquín Aníbal Rodriguez
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Leonel Perez Alamino
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Hernán Del Sel
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Cesar Angel Pesciallo
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
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Li X, Xu W, Yin Y, Zhang X, Xiong Z, Yang Y. A case of recurrent proximal femoral fracture after open reduction and internal fixation with bilateral locking plates for a Rorabeck type II periprosthetic fracture. Int J Surg Case Rep 2024; 123:110044. [PMID: 39178582 PMCID: PMC11387792 DOI: 10.1016/j.ijscr.2024.110044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 08/26/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Periprosthetic distal femur fractures (PDFFs) are rare complications that may occur during or after total knee arthroplasty (TKA). The incidence of PDFFs is increasing. Plate internal fixation has demonstrated positive results. However, there is limited research available on the recurrence of periimplant fractures following open reduction and internal fixation with bilateral locking plates. CASE PRESENTATION A 70-year-old female patient was diagnosed with a Rorabeck type II fracture. Based on the patient's physical condition and available surgical options, minimally invasive open reduction, bilateral plate fixation, and allograft artificial bone grafting were chosen. The postoperative recovery was successful. However, the patient experienced a fall 2 months after the surgery, resulting in a proximal femoral fracture. After considering the patient's condition and family preferences, conservative treatment was ultimately decided upon. CLINICAL DISCUSSION Minimally invasive bilateral Locking Compression Plate (LCP) as a surgical approach can effectively reduce surgical risks prior to the procedure. Careful selection of screws and the use of C-arm fluoroscopy during plate contouring and fixation are essential to prevent screw penetration through the contralateral cortex. Treatment outcomes were not impacted in patients with normal bone mass; however, in this particular case, the patient had severe osteoporosis, significantly increasing the risk of refracture. It is crucial to improve postoperative monitoring and raise awareness about safety among patients and their families. CONCLUSION The management of periprosthetic distal femur fractures (PDFFs) is influenced by the type of fracture and bone quality. Mechanical stability and stress dispersion of internal fixation are key factors to consider. In the perioperative setting, involving experienced clinicians is essential to reduce the risk of secondary injuries that may impact treatment outcomes, especially when choosing screws for fixation in patients with low bone density.
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Affiliation(s)
- Xiaobing Li
- Department of Joint Surgery, Yueyang People 's Hospital, Hunan Normal University, No.263 Baling East Road, Yueyang 414000, Hunan, China
| | - Wenhe Xu
- Department of Joint Surgery, Yueyang People 's Hospital, Hunan Normal University, No.263 Baling East Road, Yueyang 414000, Hunan, China.
| | - Yongqiang Yin
- Department of Joint Surgery, Yueyang People 's Hospital, Hunan Normal University, No.263 Baling East Road, Yueyang 414000, Hunan, China
| | - Xu Zhang
- Department of Joint Surgery, Yueyang People 's Hospital, Hunan Normal University, No.263 Baling East Road, Yueyang 414000, Hunan, China
| | - Zhizheng Xiong
- Department of Joint Surgery, Yueyang People 's Hospital, Hunan Normal University, No.263 Baling East Road, Yueyang 414000, Hunan, China
| | - Yuanqing Yang
- Department of Joint Surgery, Yueyang People 's Hospital, Hunan Normal University, No.263 Baling East Road, Yueyang 414000, Hunan, China
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Duignan JA, Newman C, Sheikh A, Ouellette HA. Musculoskeletal Applications of Dual Energy Computed Tomography (DECT): The Established and the Emerging. Semin Roentgenol 2024; 59:363-377. [PMID: 39490033 DOI: 10.1053/j.ro.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/28/2024] [Accepted: 07/11/2024] [Indexed: 11/05/2024]
Affiliation(s)
- John A Duignan
- Department of Radiology, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Christopher Newman
- Department of Radiology, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adnan Sheikh
- Department of Radiology, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hugue A Ouellette
- Department of Radiology, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Rudolph F, Brand AG, Osterhoff G, Kleber C, Roth A, Fakler JKM. Retrograde intramedullary nail fixation with oblique fixed angle screws versus locking plates in periprosthetic supracondylar fractures after total knee arthroplasty. Eur J Trauma Emerg Surg 2024; 50:1911-1920. [PMID: 38806687 PMCID: PMC11458706 DOI: 10.1007/s00068-024-02530-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/19/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Common surgical procedures in the treatment of periprosthetic distal femur fractures (PPFF) include osteosynthesis with fixed angle locking plates (LP) and retrograde intramedullary nails (RIN). This study aimed to compare LPs to RINs with oblique fixed angle screws in terms of complications, radiographic results and functional outcome. METHODS 63 PPFF in 59 patients who underwent treatment in between 2009 and 2020 were included and retrospectively reviewed. The anatomic lateral and posterior distal femoral angle (aLDFA and aPDFA) were measured on post-surgery radiographs. The Fracture Mobility Score (FMS) pre- and post-surgery, information about perceived instability in the operated leg and the level of pain were obtained via a questionnaire and previous follow-up (FU) examinations in 30 patients (32 fractures). RESULTS The collective (median age: 78 years) included 22 fractures treated with a RIN and 41 fractures fixed with a LP. There was no difference in the occurrence of complications (median FU: 21.5 months) however the rate of implant failures requiring an implant replacement was higher in fractures treated with a LP (p = 0.043). The aPDFA was greater in fractures treated with a RIN (p = 0.04). The functional outcome was comparable between both groups (median FU: 24.5 months) with a lower outcome in the post-surgery FMS (p = < 0.001). CONCLUSION Fractures treated with RIN resulted in an increased recurvation of the femur however the rate of complications and the functional outcome were comparable between the groups. The need for implant replacements following complications was higher in the LP group.
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Affiliation(s)
- Franziska Rudolph
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
- Department of Traumatology, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Alexander G Brand
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Christian Kleber
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Andreas Roth
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Johannes K M Fakler
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
- Department of Trauma-, Hand-, Reconstructive- and Spine Surgery, Hospital of Passau, Innstraße 76, 94032, Passau, Germany
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Chantelot C, Saab M, Bégué T, Kaba A, Favreau H, Ehlinger M. Periprosthetic fracture around total knee arthroplasty: What are the advantages of minimal-invasive surgery? Injury 2024; 55 Suppl 1:111351. [PMID: 39069343 DOI: 10.1016/j.injury.2024.111351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/11/2023] [Accepted: 01/14/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES Periprosthetic femur fractures after total knee arthroplasty in older adults are mostly treated by internal fixation. Members of the GETRAUM (French Orthopedic Trauma Society) sought to compare two surgical techniques - conventional open surgery and minimally invasive surgery - with the aim of analyzing the patients' functional recovery. We hypothesized that a minimally invasive technique would produce better early functional outcomes with recovery of independence. MATERIALS AND METHODS This retrospective multicenter study of patients treated between 2009 and 2015 consisted of 90 fractures with a follow-up of 1 year. Demographic, preoperative data and the characteristics of fractures, type of fixation and the surgeon's experience level were collected. The endpoints were the Parker Mobility score, Katz ADL, place of residence at the time of fracture and at 6 months and one-year follow-up. All complications and one-year mortality during the follow up were searched. RESULTS At 6 months follow-up, the minimally invasive technique contributed to significantly better functional recovery as measured by the Parker (p < 0.05) and Katz scores (p < 0.05). However, there were no differences in these scores at one-year follow-up. The complication rate was 31% at one year follow-up. Mortality rate was 12 % (11 patients). CONCLUSION Our hypothesis was confirmed, as there was a difference between techniques that impacted functional recovery and independence, but only in the early postoperative phase. A minimally invasive technique appears to be beneficial in the short term for distal femur fractures after total knee arthroplasty but must be evaluated in a comparative and prospective study to fully confirm its reliability.
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Affiliation(s)
- Christophe Chantelot
- Service de Traumatologie, Hôpital Roger Salengro, CHU de Lille, F-59000, Lille, France
| | - Marc Saab
- Service de Traumatologie, Hôpital Roger Salengro, CHU de Lille, F-59000, Lille, France.
| | - Thierry Bégué
- Service de Traumatologie/orthopédie, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140, Clamart, France
| | - Arnaud Kaba
- Service de Traumatologie, Hôpital Général, 130 Avenue Louis Herbeaux, 59240, Dunkerque, France
| | - Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie, 1 avenue Molière, 67098, Strasbourg, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, 1 avenue Molière, 67098, Strasbourg, France
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12
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Obbelode F, Landschoof S, Kreitz N, Kühne CA. [Periprosthetic fractures-Diagnostics, classification and treatment]. Z Gerontol Geriatr 2023; 56:688-696. [PMID: 36459188 DOI: 10.1007/s00391-022-02139-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/26/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Due to the increase in hip and knee prosthetic as a result of the demographic changes, with raised levels of activity among older persons with geriatric comorbidities, a continuous increase in periprosthetic fractures can be observed. OBJECTIVE The incidence and causes of periprosthetic fractures, presentation of diagnostic pathways and derivation of a recommendation according to generally accepted classifications. MATERIAL AND METHOD Literature search of basic scientific work, recommendations of experts as well as evaluation of own patient collective. CONCLUSION With a growing number of prosthetic interventions in combination with increasing patient age, an increase in periprosthetic fractures is to be expected. The treatment of periprosthetic fractures is complex and requires detailed analysis of the location of the fracture and its morphology as well as the recognition of possibly loosened prosthetic material. Based on this information, the correct surgical treatment can be determined and scheduled in an appropriate center of care. In geriatric patients with corresponding comorbidities, an individual holistic treatment plan should be developed.
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Affiliation(s)
- F Obbelode
- Klinik für Unfall- und Handchirurgie, Zentrum für Alterstraumatologie, Schön-Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland
| | - S Landschoof
- Klinik für Unfall- und Handchirurgie, Zentrum für Alterstraumatologie, Schön-Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland
| | - N Kreitz
- Klinik für Unfall- und Handchirurgie, Zentrum für Alterstraumatologie, Schön-Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland
| | - C A Kühne
- Klinik für Unfall- und Handchirurgie, Zentrum für Alterstraumatologie, Schön-Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland.
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13
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Ghanem M, Kalb A, Heyde CE, Roth A. Management of complications of mega-implants following treatment of primary and periprosthetic fractures of the lower extremities. Sci Rep 2023; 13:17594. [PMID: 37845299 PMCID: PMC10579354 DOI: 10.1038/s41598-023-44992-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/14/2023] [Indexed: 10/18/2023] Open
Abstract
In recent years, indications for implanting mega-implants were established in managing major bone defects linked to revision arthroplasty due to loosening, periprosthetic fractures, re-implantation following periprosthetic joint infection, non-union following fractures as well as complex intraarticular primary fractures. This study was conducted to discuss and analyze the strategy of diagnosis and management of complications following the use of mega-implants in treating primary and periprosthetic fractures of the lower extremities. This is a monocentric retrospective study. Patients aged ≥ 18 years who underwent implantation of a megaendoprosthesis due to periprosthetic or primary fractures of the lower extremity between January 2010 and February 2023 were identified from the authors' hospital information system. We identified 96 patients with equal numbers of fractures (71 periprosthetic fractures and 25 primary fractures). 90 cases out of 96 were investigated in this study. The drop-out rate was 6.25% (six cases). The average follow-up period was 22 months (1 to 8 years) with a minimum follow-up of 1 year. The diagnosis of complications was provided on the basis of subjective symptoms, clinical signs, radiological findings and laboratory investigations such as C-reactive protein, leucocyte count and the microbiological findings. The indications for implantations of modular mega-implants of the lower extremities were periprosthetic fractures (65 cases/72.22%) and primary fractures (25 cases/27.78%). Pathological fractures due to malignancy were encountered in 23 cases (25.56%), in one case due to primary tumor (1.11%) and 22 cases due to metastatic lesions (24.44%). Two cases (2.22%) presented with primary intraarticular fractures with severe osteoporosis and primary arthrosis. In all cases with malignancy staging was performed. Regarding localization, proximal femur replacement was encountered in 60 cases (66.67%), followed by distal femur replacement (28 cases/31.11%) and total femur replacement (2 cases/2.22%). The overall complication rate was 23.33% (21 complications in 21 patients). The most common complication was dislocation which was encountered in nine cases (10%), all following proximal femoral replacement (9 cases out of 60, making 15% of cases with proximal femoral replacement). The second most common complication was infection (six cases, 6.67%), followed by four aseptic loosenings (4.44%), further intraoperative periprosthetic fracture in one case (1.11%) and a broken implant in one case (1.11%). We noticed no cases with wear and tear of the polyethylene components and no cases of disconnections of the modular components. Mega-endoprostheses enable versatile management options in the treatment of primary and periprosthetic fractures of the lower extremities. The rate of complications such as loosening, implant failure, dislocation and infection are within an acceptable range in this preliminary analysis. However, implantation of mega-endoprostheses must be strictly indicated due the limited salvage options following surgery.
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Affiliation(s)
- M Ghanem
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig (Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR), Liebigstrasse 20, 04103, Leipzig, Germany.
- Department of Physical Therapy and Rehabilitation, University Hospital Leipzig, Leipzig, Germany.
| | - A Kalb
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig (Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR), Liebigstrasse 20, 04103, Leipzig, Germany
| | - C-E Heyde
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig (Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR), Liebigstrasse 20, 04103, Leipzig, Germany
| | - A Roth
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig (Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR), Liebigstrasse 20, 04103, Leipzig, Germany
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Miettinen S, Sund R, Törmä S, Kröger H. How Often Do Complications and Mortality Occur After Operatively Treated Periprosthetic Proximal and Distal Femoral Fractures? A Register-based Study. Clin Orthop Relat Res 2023; 481:1940-1949. [PMID: 37036391 PMCID: PMC10499103 DOI: 10.1097/corr.0000000000002638] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/25/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND The incidence of periprosthetic femoral fractures is increasing because of an increasing number of primary THAs and TKAs. High rates of complications and mortality are associated with periprosthetic fractures, but few studies have evaluated and compared the population-based incidences of these events after fractures. QUESTIONS/PURPOSES (1) What is the annual incidence of periprosthetic fractures treated with surgery in one hospital district in Finland? (2) How are those incidences changing over time? (3) What is the risk of complications, reoperations, and death after those injuries? METHODS This register-based study evaluated 2259 patients who underwent revision THA or TKA or any surgery for a femoral fracture between January 2004 and December 2016 at the only hospital in our district where these types of operations are performed. During the study period, the diagnosis and operation codes of the operated-on patients varied greatly, and they were somewhat inaccurate. We thus evaluated radiographs of all 2259 patients one by one, and created inclusion and exclusion criteria based on radiologic findings and medical records. Of those, 12% (279 of 2259) had periprosthetic fractures that met the inclusion criteria, and from these, we formed two study groups (periprosthetic proximal femur fractures, n = 171; periprosthetic distal femur fractures, n = 108). Eighty-eight percent (1980 of 2259) of the patients were excluded because they were treated for a condition other than periprosthetic femoral fracture. The follow-up period ended in December 2019 or at the time the patient died. To evaluate the population-based incidence, we drew the number of individuals with THA or TKA in the hospital district from the Finnish Arthroplasty Register and the Finnish Hospital Discharge Register. The characteristics of patients with operatively treated periprosthetic femoral fractures were evaluated in terms of age, gender, fracture type, implant type, and time from the index operation to periprosthetic fracture. The annual incidences of periprosthetic femoral fractures are summarized per 1000 person-years of individuals living with an implanted THA or TKA and per 100,000 individuals per year living in our hospital district. The risks of death, complications, and reoperations were evaluated for both groups, and comparisons were made in terms of patient characteristics. RESULTS The mean annual incidence of operatively treated periprosthetic proximal femur fractures per 1000 people living with THA implants was 2.3 ± 0.9 (95% confidence interval 1.8 to 2.7) per year, and for those with periprosthetic distal femur fractures with TKA implants, it was 1.3 ± 0.6 (95% CI 1.0 to 1.7). There was an increasing trend in the incidence of periprosthetic proximal femur fractures from 1.6 to 3.8 (95% CI 1.8 to 2.8) per 1000 arthroplasties, and it increased from 0.4 to 1.7 (95% CI 2.4 to 4.4) for periprosthetic distal femur fractures between 2004 and 2016. The mean population-based incidence of periprosthetic proximal femur fractures per 100,000 person-years was 5.3 ± 2.2 (95% CI 4.1 to 6.4) per year, and for periprosthetic distal femur fractures, it was 3.4 ± 1.7 (95% CI 2.5 to 4.4). The incidence of periprosthetic proximal femur fractures related to 100,000 person-years increased from 3.2 to 8.9 (95% CI 3.9 to 6.6), while the incidence of periprosthetic distal femur fractures increased from 1.3 to 4.4 (95% CI 2.4 to 4.8) during the study period. The cumulative incidence of major complications after periprosthetic proximal femur fracture was 8.8% at 1 year (95% CI 5.1% to 13.6%) and 12.3% at 10 years (95% CI 7.5% to 18.4%), and after periprosthetic distal femur fracture, it was 7.4% at 1 year (95% CI 3.5% to 13.4%) and 9.3% at 10 years (95% CI 4.7% to 15.7%). The cumulative incidence of reoperation after periprosthetic proximal femur fracture was 10.5% at 1 year (95% CI 6.5% to 15.7%) and 13.5% at 10 years (95% CI 8.9% to 19.1%), and for periprosthetic distal femur fracture, it was 8.3% at 1 year (95% CI 4.1% to 14.5%) and 13.8% at 10% years (95% CI 7.8% to 21.4%). The cumulative incidence of death after periprosthetic proximal femur fracture was 8.2% at 1 year (95% CI 4.7% to 12.9%) and 47.3% at 10 years (95% CI 38.1% to 55.9%), and after periprosthetic distal femur fractures, it was 14.8% at 1 year (95% CI 8.8% to 22.2%) and 67.8% at 10 years (95% CI 56.3% to 76.9%). CONCLUSION The increased use of THA and TKA has led to an increase in the incidence of operatively treated periprosthetic fractures, which means there will be more revisions in the future. Older age, frailty of these patients, and often-complicated fracture patterns are related to a high rate of complications, reoperations, and mortality. Healthcare systems must prepare for a large increase in revisions for periprosthetic fracture, which are morbid events for patients and costly ones for healthcare systems. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Simo Miettinen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Health and Social Economics Unit, Department of Health and Social Care Systems, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Samuli Törmä
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Caterini A, Luciano C, Rovere G, Ziranu A, Farsetti P, De Maio F. Periprosthetic distal femoral fractures after total knee replacement treated by ORIF. Mid to long-term follow-up study in 12 patients. Orthop Rev (Pavia) 2023; 15:87871. [PMID: 37786428 PMCID: PMC10542000 DOI: 10.52965/001c.87871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Periprosthetic fractures following total knee arthroplasty are a quite uncommon traumatic lesion that often are present in elderly patients with osteoporosis and comorbidities. The most common periprosthetic fracture affects the distal femur. The main internal fixation techniques are ORIF with a locking plate and retrograde intramedullary nailing. In the present study, we report the medium-long term results in 12 patients with a distal femoral periprosthetic fracture stabilized with a locking plate. We reviewed 12 patients affected by a periprosthetic distal femur fracture surgically treated between 2010 and 2016 by ORIF using a locking compression plate after an average follow-up of 5.75 years. The average age of the patients at diagnosis was 78 years. The mean interval time between knee arthroplasty and distal femoral fracture was 8.25 years. Clinical results were assessed using the WOMAC score, while radiographic results according to Beals and Tower's criteria. All fractures of our series were type II according to the Rorabeck and Taylor classification. At follow-up, the WOMAC score ranged from 40.5 to 76.5 points (average 53.92). Radiographic results, according to Beals and Tower's criteria, were excellent in 5 patients and good in 7. All patients returned to their previous daily activities. We believe that reduction and internal fixation with a locking plate is a surgical option of treatment that provides satisfactory clinical and radiological results in Rorabeck type II periprosthetic distal femoral fractures.
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Affiliation(s)
- Alessandro Caterini
- Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology University of Rome Tor Vergata, Italy
| | - Claudia Luciano
- Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology University of Rome Tor Vergata, Italy
| | - Giuseppe Rovere
- Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology University of Rome Tor Vergata, Italy
| | - Antonio Ziranu
- Orthopaedics Catholic University of the Sacred Heart, Rome, Italy
| | - Pasquale Farsetti
- Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology University of Rome Tor Vergata, Italy
| | - Fernando De Maio
- Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology University of Rome Tor Vergata, Italy
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Díaz-Dilernia F, García-Mansilla A, Nicolino T, Costantini J, Carbo L. [Translated article] Total knee arthroplasty is effective in patients with Parkinson's disease. Functional assessment and analysis of complications. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T418-T425. [PMID: 37311479 DOI: 10.1016/j.recot.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/03/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Thanks to improvements in the medical treatment of Parkinson's disease (PD), the life expectancy of these patients has increased, but the overall outcome after total knee arthroplasty (TKA) is controversial. We aim to analyse a series of patients with PD, evaluating their clinical status, functional results, complications and survival rates after TKA. METHODS We retrospectively studied 31 patients with PD operated between 2014 and 2020. The mean age was 71 years (SD±5.8). There were 16 female patients. The mean follow-up was 68.2 months (SD±36). We used the knee scoring system (KSS) and the visual analogue scale (VAS) for the functional evaluation. The modified Hoehn and Yahr scale was used to assess the severity of PD. All complications were recorded, and survival curves were performed. RESULTS The mean postoperative KSS evaluation had an increase of 40 points [35 (SD±15) vs 75 (SD±15) (p<.001)]. The mean postoperative VAS decreased 5 points [8 (SD±2) vs 3 (SD±2) (p<.001)]. Thirteen patients reported being very satisfied, 13 were satisfied, and only 5 were poorly satisfied. Seven patients suffered surgical complications, and 4 patients had recurrent patellar instability. At a mean 68.2 months follow-up, the overall survival rate was 93.5%. When considering the secondary patellar resurfacing as the endpoint, the survival rate was 80.6%. CONCLUSIONS In this study, TKA was associated with excellent functional outcomes in patients with PD. At a mean 68.2 months follow-up, TKA had excellent survivorship in the short term, with recurrent patellar instability as the most common complication. Even though these findings confirm the effectiveness of TKA in this population, a thorough clinical evaluation and multidisciplinary approach are needed to decrease the likelihood of complications.
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Affiliation(s)
- F Díaz-Dilernia
- Sunnybrook Health Sciences Centre/Holland Orthopaedic & Arthritic Centre, Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - A García-Mansilla
- Unidad de Cirugía de Rodilla, Departamento de Ortopedia, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - T Nicolino
- Unidad de Cirugía de Rodilla, Departamento de Ortopedia, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Costantini
- Unidad de Cirugía de Rodilla, Departamento de Ortopedia, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L Carbo
- Unidad de Cirugía de Rodilla, Departamento de Ortopedia, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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17
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Wall R, Syed F, Arastu M, Riemer B, Boutefnouchet T. Treatment of supracondylar periprosthetic femoral fractures with retrograde intramedullary nailing versus distal femoral plating: A systematic review and meta-analysis of current evidence. Orthop Traumatol Surg Res 2023; 109:103489. [PMID: 36442809 DOI: 10.1016/j.otsr.2022.103489] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 05/18/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Supracondylar periprosthetic fractures, when amenable to fixation, can be treated by either retrograde intramedullary nailing (RIMN) or plating. There is paucity of evidence regarding the superiority of one fixation method over the other. This review aims to determine which fixation method leads to better functional outcomes and perioperative complications. HYPOTHESIS Superiority of intramedullary nailing in terms of fracture healing and surgical complications when compared to distal femoral plating. MATERIALS AND METHODS Using PRISMA guidelines, a systematic search was performed. Studies which reported comparative outcome data following the two interventions were included. Qualitative data analysis and narrative synthesis were reported. Pooled comparisons were conducted when similar quantifiable outcomes were reported in a minimum of three studies. RESULTS A total of 151 records were generated by the search. Eight studies met the eligibility criteria so were included in the final analysis. The studies comprised a total of 407 cases, with a follow up period ranging from 1 to 15 years. 252 cases were treated with plate fixation and 155 with RIMN. All studies were mitigated by heterogeneity and methodological limitations. The review showed marked variation in descriptive fracture classifications. Narrative data synthesis was conducted. Although guarded by the methodological limitations of individual studies, outcomes showed that mean time to union was equivalent; 5.88 months for RIMN compared to 6.75 months in plating, standardised mean difference=0.28 (95% CI -0.02-0.58). Similarly, no statistically significant differences were reported between RIMN and plating for deep infection (OR:1.41 95%CI 0.40-5.00) and revision surgery (OR: 0.74, 95%CI 0.39-1.41). DISCUSSION Clinical outcomes showed a tendency that favours intramedullary nailing; however, generalisation of results was not possible. Future priority must be awarded to higher quality research in the form of a collaborative multicentre observational studies to delineate appropriate major diagnostic categories, ultimately informing a large comparative trial using condition specific validated outcome measures. LEVEL OF EVIDENCE III, meta-analysis.
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Affiliation(s)
- Rosemary Wall
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK.
| | - Farhan Syed
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Mateen Arastu
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Bryan Riemer
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
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Díaz-Dilernia F, García-Mansilla A, Nicolino T, Costantini J, Carbo L. Total knee arthroplasty is effective in patients with Parkinson's disease. Functional assessment and analysis of complications. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:418-425. [PMID: 37031862 DOI: 10.1016/j.recot.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION Thanks to improvements in the medical treatment of Parkinson's disease (PD), the life expectancy of these patients has increased, but the overall outcome after total knee arthroplasty (TKA) is controversial. We aim to analyse a series of patients with PD, evaluating their clinical status, functional results, complications and survival rates after TKA. METHODS We retrospectively studied 31 patients with PD operated between 2014-2020. The mean age was 71 years (SD±5.8). There were 16 female patients. The mean follow-up was 68.2 months (SD±36). We used the Knee Scoring System (KSS) and the Visual Analog Scale (VAS) for the functional evaluation. The Modified Hoehn and Yahr Scale was used to assess the severity of PD. All complications were recorded, and survival curves were performed. RESULTS The mean postoperative KSS evaluation had an increase of 40 points [35 (SD±15) vs 75 (SD±15) (P<.001)]. The mean postoperative VAS decreased 5 points [8 (SD±2) vs 3 (SD±2) (P<.001)]. Thirteen patients reported being very satisfied, 13 were satisfied, and only 5 were poorly satisfied. Seven patients suffered surgical complications, and 4 patients had recurrent patellar instability. At a mean 68.2 months follow-up, the overall survival rate was 93.5%. When considering the secondary patellar resurfacing as the endpoint, the survival rate was 80.6%. CONCLUSIONS In this study, TKA was associated with excellent functional outcomes in patients with PD. At a mean 68.2 months follow-up, TKA had excellent survivorship in the short term, with recurrent patellar instability as the most common complication. Even though these findings confirm the effectiveness of TKA in this population, a thorough clinical evaluation and multidisciplinary approach are needed to decrease the likelihood of complications.
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Affiliation(s)
- F Díaz-Dilernia
- Sunnybrook Health Sciences Centre/Holland Orthopaedic & Arthritic Centre, Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canadá.
| | - A García-Mansilla
- Unidad de Cirugía de Rodilla, Departamento de Ortopedia, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - T Nicolino
- Unidad de Cirugía de Rodilla, Departamento de Ortopedia, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Costantini
- Unidad de Cirugía de Rodilla, Departamento de Ortopedia, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L Carbo
- Unidad de Cirugía de Rodilla, Departamento de Ortopedia, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Shon OJ, Cho SJ, Kim GB. Long locking plate combined with locking attachment plate in patients with periprosthetic femoral fracture around ipsilateral stem after total knee arthroplasty. BMC Musculoskelet Disord 2023; 24:594. [PMID: 37475013 PMCID: PMC10357702 DOI: 10.1186/s12891-023-06726-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The purpose of this study was to introduce the surgical technique using long locking plate and locking attachment plate (LAP) in patient with periprosthetic femoral fracture around ipsilateral stem after total knee arthroplasty (TKA). Moreover, we sought to investigate the outcomes of this fixation technique and to propose a new subtype in the existing classification of periprosthetic femoral fractures. METHODS From January 2013 to January 2022, thirty-four consecutive periprosthetic femoral fractures around ipsilateral stem following TKA with minimum 1-year follow-up were enrolled in this study. Most cases were fixed with long-locking plate and LAP using the MIPO technique. For subgroup analysis, we classified patients with stemmed hip implant (group H) and stemmed knee implant (group K). Bone union, American Knee Society Score (AKSS) scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, the Western Ontario and McMaster Universities Osteoarthritis Index for pain and function, and range of motion were investigated. RESULTS The number of group H and K were 24 patients (70.6%) and 10 patients (29.4%), respectively. The mean age at operation was 71.5 years (range, 65‒85 years), and the mean follow-up period was 27.5 months (range, 12‒72 months). Bone union was confirmed radiographically in all patients, and the mean union time was 4.9 months (range, 3.5‒6 months). There were no significant differences in radiographic and clinical outcomes between the groups. CONCLUSIONS Long-locking plate combined with LAP showed favorable radiographic and clinical outcomes in patients with periprosthetic femoral fracture around ipsilateral stem after TKA. LEVEL OF EVIDENCE Level IV, Retrospective Case Series.
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Affiliation(s)
- Oog-Jin Shon
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-Ro Nam-Gu, Daegu, 42415, Republic of Korea
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-Ro Nam-Gu, Daegu, 42415, Republic of Korea
| | - Seung Jae Cho
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-Ro Nam-Gu, Daegu, 42415, Republic of Korea
| | - Gi Beom Kim
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-Ro Nam-Gu, Daegu, 42415, Republic of Korea.
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-Ro Nam-Gu, Daegu, 42415, Republic of Korea.
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Holzer LA, Borotschnig L, Holzer G. Evaluation of FRAX in patients with periprosthetic fractures following primary total hip and knee arthroplasty. Sci Rep 2023; 13:7145. [PMID: 37130875 PMCID: PMC10154289 DOI: 10.1038/s41598-023-34230-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 04/26/2023] [Indexed: 05/04/2023] Open
Abstract
The fracture risk assessment tool (FRAX) is a tool which calculates an individual 10-year fracture risk based on epidemiological data in patients with a risk of osteporosis. The aim of this study was to evaluate the value of FRAX to estimate the risk of postoperative periprosthetic fractures (PPF) in patients following with total hip and knee arthroplasty. 167 patients (137 periprosthetic fractures in total hip arthroplasty and 30 periprosthetic fractures in total knee arthroplasty) were included in this study. Patients' data was retrieved retrospectively. In each patient the 10-year probability of a major osteoporotic fracture (MOF) and an osteoporotic hip fracture (HF) was calculated using FRAX. According to the NOGG guideline 57% of total hip arthroplasty (THA) patients and 43.3% of total knee arthroplasty (TKA) patients were in need of osteoporosis treatment, whereas only 8% and 7% received an adequate one respectively. 56% of the patients with PPF after THA and 57% of the patients with PPF after TKA reported about a previous fracture. Significant associations between the 10-year probability of a MOF and HF calculated by FRAX and PPF in THA and TKA were seen. The results of the present study show that FRAX might have the potential to estimate the PPF in patients following THA and TKA. FRAX should be calculated before and after THA or TKA in order to assess the risk and counsel patients. The data show a clear undertreatment of patients with PPF in respect to osteoporosis.
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Affiliation(s)
- Lukas A Holzer
- Department of Orthopaedic Surgery, AUVA Trauma Center Klagenfurt, Waidmannsdorferstraße 35, 9020, Klagenfurt am Wörthersee, Austria.
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria.
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, Perth, Australia.
- Perth Orthopaedic and Sports Medicine Centre, Perth, Australia.
| | - Lisa Borotschnig
- Department of Orthopaedic Surgery, AUVA Trauma Center Klagenfurt, Waidmannsdorferstraße 35, 9020, Klagenfurt am Wörthersee, Austria
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Gerold Holzer
- Department of Orthopedics and Traumatology, Medical University of Vienna, Vienna, Austria
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21
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Hao LJ, Wen PF, Zhang YM, Song W, Chen J, Ma T. Treatment of periprosthetic knee infection and coexistent periprosthetic fracture: A case report and literature review. World J Clin Cases 2023; 11:2321-2328. [PMID: 37122513 PMCID: PMC10131023 DOI: 10.12998/wjcc.v11.i10.2321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) and periprosthetic fracture (PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications with details on the characteristics, treatment strategy, and outcome.
CASE SUMMARY A 69-year-old female patient who suffered from PJI and PPF following total knee arthroplasty was treated by a two-stage revision surgery. After thorough foreign material removal and debridement, we used a plate that was covered with antibiotic-loaded bone cement to link with a hand-made cement spacer to occupy the joint space and fix the fracture. Although the infection was cured, the fracture did not heal and caused bone defect due to the long interval between debridement and revision. In the revision surgery, a cemented stem and cortical allogenic splints were used to reconstruct the fracture and bone defect. At the final follow-up 27 mo after revision, the patient was satisfied with postoperative knee functions with satisfactory range of motion (104º) and Hospital for Special Surgery knee score (82 points). The radiographs showed no loosening of the prosthesis and that the bone grafts healed well with the femur.
CONCLUSION Our two-stage revision surgery has proved to be successful and may be considered in other patients with PJI and PPF.
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Affiliation(s)
- Lin-Jie Hao
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710000, Shaanxi Province, China
| | - Peng-Fei Wen
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710000, Shaanxi Province, China
| | - Yu-Min Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710000, Shaanxi Province, China
| | - Wei Song
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710000, Shaanxi Province, China
| | - Juan Chen
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710000, Shaanxi Province, China
| | - Tao Ma
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710000, Shaanxi Province, China
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Al-Jabri T, Ridha M, McCulloch RA, Jayadev C, Kayani B, Giannoudis PV. Periprosthetic distal femur fractures around total knee replacements: A comprehensive review. Injury 2023; 54:1030-1038. [PMID: 36854630 DOI: 10.1016/j.injury.2023.02.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
With a growing number of patients undergoing total knee replacements globally, coupled with an elderly population, the incidence of periprosthetic fractures around total knee replacements is increasing. As such, this is a highly topical subject that is gaining increasing interest within the orthopaedic community. This review provides a narrative synthesis of the most contemporary literature regarding distal femoral periprosthetic fractures. We review the related epidemiology, initial patient evaluation, the evolution and relevance of the classification systems and treatment options, particularly related to endoprosthetics and hybrid fixation constructs. The latest orthopaedic evidence related to this topic has been included.
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Affiliation(s)
- Talal Al-Jabri
- Trauma and Orthopaedic Surgery, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK; Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, London, Stanmore HA7 4LP, UK; King Edward VII's Hospital, 5-10 Beaumont Street, Marylebone, London W1G 6AA, UK.
| | - Mohamed Ridha
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, London, Stanmore HA7 4LP, UK
| | - Robert Allan McCulloch
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, London, Stanmore HA7 4LP, UK
| | - Chethan Jayadev
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, London, Stanmore HA7 4LP, UK; King Edward VII's Hospital, 5-10 Beaumont Street, Marylebone, London W1G 6AA, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, Fitzrovia, London NW1 2BU, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, UK; NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
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Vicenti G, Bizzoca D, Solarino G, Carrozzo M, Belluati A, D'Arienzo A, De Carolis O, Moretti B. Periprosthetic femoral re-fractures pathogenesis, classification, and surgical implications. Injury 2023; 54 Suppl 1:S24-S30. [PMID: 33218615 DOI: 10.1016/j.injury.2020.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 11/10/2020] [Indexed: 02/02/2023]
Abstract
Periprosthetic femoral re-fractures (PFRFs) represent an emerging challenge for orthopaedic surgeons, since their incidence is growing in the last years, but very few experiences about their management have been currently published. The present study aims to (1) introduce, for the first time, an etiologic classification for PRFRs and (2) to provide surgical and pharmacological tips for the correct management of these injuries. Periprosthetic femoral re-fractures (PFRFs) could be classified into traumatic-PFRFs (T-PFRFs) and pathological-PFRFs (P-PFRFs). T-PFRFs, i.e. the "true" periprosthetic re-fractures, present as new fracture lines occurring proximally or distally to a previous periprosthetic fracture, that has correctly healed. They are generally unpredictable injuries but, in selected cases, it is possible to predict them by analyzing the construct used in the treatment of the previous periprosthetic fracture. P-PFRFs, on the other hand, define re-fractures occurring on a previous periprosthetic non-union or delayed union: the new fracture line appears in the same district of the old one. According to the etiologic factors influencing the P-PFRFs pathogenesis, it is possible to define re-fractures caused by mechanical failures, biological failures, septic failures and multifactorial failures, i.e., a combination of the previously mentioned concerns. A successful postoperative outcome, following the surgical management of PFRFs, requires the correct identification of all the underlying causes, which should be promptly and appropriately managed.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy.
| | - Davide Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Alberto Belluati
- Ospedale "Santa Maria delle Croci", Ravenna, AUSL Romagna, Italy
| | | | - Oronzo De Carolis
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
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24
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Bernstein BP, Rivkin G, Weil YA, Greenberg A, Madison BB, Areu MM, Joda OB, Berry KL, Nortje M. How resources affect management of periprosthetic fractures of the distal femur: perspectives from Israel, South Sudan, and South Africa. OTA Int 2023; 6:e238. [PMID: 37006452 PMCID: PMC10064638 DOI: 10.1097/oi9.0000000000000238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/14/2022] [Indexed: 03/30/2023]
Abstract
Periprosthetic fractures of the distal femur have significant morbidity in both total hip and total knee arthroplasty (THA and TKA, respectively). The incidence of these fractures is growing, with the predominant mechanism of injury being a fall from a standing height and therefore considered fragility fractures. In many countries, improved public funding and a flourishing private health care sector, when coupled with increased life expectancy, translates to more older patients receiving both TKA and THA and therefore an increased prevalence of periprosthetic fractures and their associated complications. These fractures may occur below a long stem THA, above a TKA, or between the two (so-called "interprosthetic fracture"). We will outline fracture classification, risk factors, diagnosis, and treatment options, highlighting perspectives on treating these fractures in Israel, South Africa, and South Sudan. These countries represent differing access to resources, varied comorbidity factors, and differing health care systems. The points of difference and the points of similarity will be considered.
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25
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Fu P, Liang W, Gao Z, Chen G, Fan W. Optimal surgical treatment for periprosthetic distal femoral fractures after total knee arthroplasty: a Bayesian-based network analysis. J Orthop Surg Res 2023; 18:122. [PMID: 36803522 PMCID: PMC9942323 DOI: 10.1186/s13018-023-03586-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 02/07/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The surgical methods for periprosthetic distal femoral fractures (PDFFs) after total knee arthroplasty included locking compression plate (LCP), retrograde intramedullary nailing (RIMN), and distal femoral replacement (DFR). However, the optimal treatment remains controversial. We performed a network meta-analysis (NMA) to provide the optimal surgical method for PDFFs. MATERIALS AND METHODS Electronic databases, including Embase, Web of Science, Cochrane Library, and PubMed, were searched for studies that compared LCP, RIMN, and DFR for PDFFs. The quality of the included studies was assessed according to the Newcastle-Ottawa scale. Pairwise meta-analysis was performed by Review Manager version 5.4. The NMA was conducted in Aggregate Data Drug Information System software version 1.16.5. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for postoperative complications and reoperations. RESULTS A total of 19 studies and 1198 patients were included, of whom 733 for LCP, 282 for RIMN, and 183 for DFR. Pairwise meta-analysis comparing LCP to RIMN and LCP to DFR showed no significant difference in complications and reoperations except that RIMN had a higher risk of malunion comparing to LCP (OR 3.05; 95% CI 1.46-6.34; P = 0.003). No statistically significant effects were found in the NMA of overall complications, infection, and reoperation. However, results of rank probabilities showed that DFR ranked best in overall complications and reoperation, RIMN ranked best in infection but worst in reoperation, and LCP ranked worst in infection and middle in reoperation. DISCUSSION We found similar complication rate and reoperation rate between LCP, RIMN, and DFR. The results of rank probabilities favored DFR, and further studies with high-level evidence are expected to verify the optimal surgical method for PDFFs. LEVEL OF EVIDENCE Level II; network meta-analysis.
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Affiliation(s)
- Peng Fu
- grid.412676.00000 0004 1799 0784Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China ,grid.411870.b0000 0001 0063 8301Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Wenwei Liang
- grid.412676.00000 0004 1799 0784Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhenzhen Gao
- grid.411870.b0000 0001 0063 8301Department of Clinical Oncology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Gang Chen
- grid.411870.b0000 0001 0063 8301Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Weimin Fan
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Kerr MS, Young EG, Shaath MK, Avilucea FR, Adigweme OO, Haidukewych GJ. Periprosthetic distal femur fractures treated by retrograde intramedullary nails with a 10-degree distal bend achieve significantly better post-operative radiographic alignment when compared to conventional retrograde nails. Injury 2023; 54:694-697. [PMID: 36428147 DOI: 10.1016/j.injury.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/24/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Periprosthetic distal femur fractures (PPDFFs) are a common complication after total knee arthroplasty (TKA). In the setting of well-fixed TKA components, treatment options include retrograde intramedullary nailing (rIMN) or lateral locked plating. Treatment with rIMN has historically been associated with potential for extension deformity when using conventional nails. We hypothesized that the PPDFFs treated with an intramedullary nail with a specifically designed 10-degree distal bend for periprosthetic fractures would result in improved post-operative sagittal alignment compared to conventional intramedullary nails. MATERIALS AND METHODS The study was conducted at a level-1 trauma center over a 12-year period (2010 - 2022). Patients over the age of 18 who sustained a PPDFF treated with rIMN were identified. The primary outcomes of the study were post-operative coronal and sagittal alignment determined by reviewing post-operative radiographs. RESULTS A total of 50 patients were included. Twenty-three patients were treated with a rIMN with a 10° distal bend. Twenty-seven patients were treated with a rIMN with distal bend of 5° The mean aPDFA for the 10° distal bend group was 81.7° compared to 92.8° in the 5° distal bend group (p<0.001). There were 3/23 (13%) significant sagittal plane deformities the 10° distal bend group compared to 11/27 (41%) in the 5° distal bend group (p = 0.03). There was one patient with a post-operative extension deformity in the 10° distal bend group compared to 11 patients in the 5° distal bend group (p = 0.02). CONCLUSION Retrograde intramedullary nailing of PPDFF with a 10° distal bend results in significantly better alignment in the sagittal plane when compared to a conventional 5° nail. The use of a 5° nail resulted in an extension deformity significantly more frequently. We therefore recommend the utilization of a rIMN with a 10° distal bend when treating PPDFFs. SUMMARY Periprosthetic distal femur fractures are a common complication following total knee arthroplasty. While several studies report on the use of retrograde intramedullary nails in the treatment of periprosthetic distal femur fractures, there are limited reports of the use of a novel retrograde intramedullary nail with a 10° distal bend in the treatment of these injuries. Herein we present a radiographic study comparing coronal and sagittal postoperative alignment following treatment with retrograde intramedullary nails with a 10° distal bend versus conventional retrograde nails with a 5° distal bend.
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Affiliation(s)
- Matthew S Kerr
- Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 1222 S Orange Ave, 5 Floor, Orlando, FL 32806, United States.
| | - Everett G Young
- Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 1222 S Orange Ave, 5 Floor, Orlando, FL 32806, United States
| | - M Kareem Shaath
- Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 1222 S Orange Ave, 5 Floor, Orlando, FL 32806, United States
| | - Frank R Avilucea
- Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 1222 S Orange Ave, 5 Floor, Orlando, FL 32806, United States
| | - Obinna O Adigweme
- Orlando Orthopaedic Center, University of Central Florida College of Medicine, 25W Crystal Lake Street Suite 200, Orlando, FL 32806, United States
| | - George J Haidukewych
- Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 1222 S Orange Ave, 5 Floor, Orlando, FL 32806, United States
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Biomechanical analysis of different fixation methods for Rorabeck II supracondylar femoral fractures after total knee arthroplasty. Knee 2023; 41:204-213. [PMID: 36724579 DOI: 10.1016/j.knee.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 11/24/2022] [Accepted: 12/08/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Locking plate (LP) and retrograde intramedullary nailing (RIMN) are widely used to fix Rorabeck II supracondylar femoral fractures after total knee arthroplasty (TKA). The biomechanical properties of the implant used for treatment influence its longevity. Therefore, we aimed to evaluate the biomechanical stability of different fixations using finite element analysis. METHODS Seven finite element models (FEMs) were established, including LP groups (short LP, long LP, and double LP), RIMN groups (short RIMN and long RIMN), and mixed groups (long LP with short RIMN and long LP with long RIMN). The stress of the implants around the fracture area was calculated to evaluate the biomechanical stability under loads. RESULTS Stress was mainly distributed around the fracture area in all models. The stress-shielding phenomenon was most evident in the short LP. The trend in maximum equivalent stress values of implants around the fracture area for the seven internal fixations was: short LP (324.63 MPa) > short RIMN (306.37 MPa) > long LP (275.06 MPa) > long RIMN (262.74 MPa) > double LP (203.19 MPa) > long LP with short RIMN (124.42 MPa) > long LP with long RIMN (112.41 MPa). We found that the double LP can better disperse the stress than a single LP, and a long LP with long RIMN can prevent stress concentration and make the stress distribution more uniform. CONCLUSION From the perspective of biomechanics, long LP with long RIMN can stabilize fractures and avoid stress concentration in Rorabeck II supracondylar femoral fractures after TKA.
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Wu J, Li Z, Huang J, Jiao X, Cao G. Staged open reduction and internal fixation with double-locking plates to treat bilateral distal femur periprosthetic fractures after total knee arthroplasty: A case report. Front Surg 2023; 9:987953. [PMID: 36684189 PMCID: PMC9852061 DOI: 10.3389/fsurg.2022.987953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/27/2022] [Indexed: 01/07/2023] Open
Abstract
Background The incidence of periprosthetic fractures after total knee arthroplasty (TKA) increases in parallel with the number of procedures. Comminuted fractures along the primary fracture line extending to the edge of the prosthesis are challenging, and bilateral fractures are rarely reported, especially with open injuries. Case presentation A 65-year-old female had undergone bilateral TKA in our hospital 5 years before admission. She was admitted with a traumatic bilateral Rorabeck type II B distal femur periprosthetic fracture (closed right, open left, Gustilo II) and was treated with bilateral staged open reduction and internal fixation (ORIF) with double-locking plates. The patient experienced a prolonged delayed fracture union and finally healed around 21 months postoperatively. The function was satisfactory after 4 years of follow-up. Conclusion ORIF with double-locking plates can be used to treat Rorabeck II B periprosthetic fracture where the primary fracture line extends beyond the edge of the prosthesis; however, there may be delayed healing or nonunion. Patients need to undergo long-term rehabilitation and endure long disability times and require good rehabilitation nursing care. Once they achieve bone healing, the treatment achieves bone preservation and substantial prosthesis survival.
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Immediate Weight-Bearing Following Biplanar Plating of Periprosthetic Femoral Fractures. Tech Orthop 2022. [DOI: 10.1097/bto.0000000000000612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mazur M, Beyer J, Elsamaloty M, Patel D, Liu J, Ebraheim NA. Surgical outcomes of periprosthetic distal femur fractures after total knee arthroplasty classified by Su et al. system. J Orthop 2022; 34:260-265. [PMID: 36148178 PMCID: PMC9486061 DOI: 10.1016/j.jor.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/26/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Periprosthetic fractures of the distal femur remain a challenge to treat due to variations in both patient- and fracture-specific factors. This study was designed to analyze the outcomes of different subtypes of periprosthetic distal femur fractures based on the Su et al. classification system. Methods Thirty-six patients were classified with Su et al. system. All Type I and II fractures were managed with a locking plate. Most Type III fractures were managed with locking plate, while two were managed with long-stem revision arthroplasty due to evidence of implant loosening. Outcomes were measured and analyzed based on healing time, revision rate, and complication rate. Results Of the 36 patients, 30 (83.3%) achieved acceptable fracture union, while the remaining 6 (16.7%) experienced either delayed union or non-union. Type I fractures showed a significantly lower healing time than Type II and III fractures managed by locking plate. Delayed union was present in the Type II group, while non-union was recorded for two Type III fractures. Need for revision was more prevalent in fracture Types II and III. Conclusion The Su et al. system of classification for periprosthetic fractures of the distal femur matches the clinical outcomes of this study and would seem to be useful in the approach to the treatment of these fractures. The majority of these fractures can be managed with locking plate with reasonable results. However, if the implant is loosened in Type III fractures, revision arthroplasty is suggested.
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Affiliation(s)
- Matthew Mazur
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Julia Beyer
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Mazzin Elsamaloty
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Devon Patel
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Jiayong Liu
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Nabil A. Ebraheim
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
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Lazic I, Burdach A, Pohlig F, von Eisenhart-Rothe R, Suren C. Utility of synovial calprotectin lateral flow test to exclude chronic prosthetic joint infection in periprosthetic fractures: a prospective cohort study. Sci Rep 2022; 12:18385. [PMID: 36319727 PMCID: PMC9626574 DOI: 10.1038/s41598-022-22892-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
The diagnosis of periprosthetic joint infection (PJI) requires a combination of various clinical, laboratory, microbiological and histopathological parameters. A concomitant periprosthetic fracture (PPF) further complicates the diagnosis as it causes a confounding local inflammatory response. Synovial calprotectin has been demonstrated as a promising biomarker of PJI. The purpose of the present study was to evaluate the reliability of synovial calprotectin for the pre- or intraoperative diagnosis of PJI in PFF. 30 patients with PPF and implant loosening were included in this prospective study. Synovial fluid with white blood cells and percentage of polymorphonuclear neutrophils, serum C-reactive protein, and synovial calprotectin using a lateral-flow assay were tested against the EBJIS definition with adjusted thresholds to account for the local inflammation. 14 patients were postoperatively classified as confirmed infections (ten total hip arthroplasties and fourtotal knee arthroplasties). The calprotectin assay yielded a sensitivity of 0.71 [0.48; 0.95], a specificity of 0.69 [0.46; 0.91], a positive predictive value of 0.67 [0.43; 0.91] and a negative predictive value of 0.73 [0.51; 0.96]. Calprotectin is a promising diagnostic parameter for the detection of a PJI in a PPF. The lateral flow assay offers prompt results, which may further assist the surgeon in addition to already existing parameters of PJI diagnostics to diagnose concomitant PJI in PPF during surgery.
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Affiliation(s)
- Igor Lazic
- grid.6936.a0000000123222966Department of Orthopaedic Surgery, Technische Universität München, School of Medicine, Klinikum rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675 Munich, Germany
| | - Alexander Burdach
- grid.6936.a0000000123222966Department of Orthopaedic Surgery, Technische Universität München, School of Medicine, Klinikum rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675 Munich, Germany
| | - Florian Pohlig
- grid.6936.a0000000123222966Department of Orthopaedic Surgery, Technische Universität München, School of Medicine, Klinikum rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675 Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- grid.6936.a0000000123222966Department of Orthopaedic Surgery, Technische Universität München, School of Medicine, Klinikum rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675 Munich, Germany
| | - Christian Suren
- grid.6936.a0000000123222966Department of Orthopaedic Surgery, Technische Universität München, School of Medicine, Klinikum rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675 Munich, Germany
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Fu P, Liang W, Gao Z, Zheng S, Fan W. Comparison of locking compression plate and distal femoral replacement for periprosthetic distal femoral fractures: a retrospective study. J Int Med Res 2022; 50:3000605221133012. [PMID: 36284456 PMCID: PMC9608071 DOI: 10.1177/03000605221133012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare the clinical outcomes of locking compression plate (LCP) and distal femoral replacement (DFR) for periprosthetic distal femoral fractures (PDFFs) after total knee arthroplasty. METHODS This retrospective study identified patients with PDFFs in an institutional database between January 2012 and December 2021. Demographic data and clinical outcomes, including postoperative complications, reoperation, 1-year mortality, Knee Society Scores (KSS) and Knee Society Functional Score (KSFS) were analysed. RESULTS In total, 12 patients treated with LCP and six patients treated with DFR were included. There was no significant difference between the LCP and DFR groups in terms of postoperative complications (25.0% versus 33.3%, respectively), reoperation (8.3% versus 0.0%), respectively, 1-year mortality (8.3% versus 16.7%, respectively) or mean ± SD KSS (80.3 ± 8.3 versus 78.0 ± 2.5, respectively). However, the mean ± SD KSFS was significantly better for patients with LCP than for those with DFR (51.8 ± 12.5 versus 37.0 ± 6.7, respectively). CONCLUSION DFR provides similar clinical outcomes compared with LCP for PDFFs. Patients with advanced age may benefit from DFR to allow early weight bearing.
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Affiliation(s)
- Peng Fu
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Wenwei Liang
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Zhenzhen Gao
- Department of Clinical Oncology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Song Zheng
- Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Weimin Fan
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Weimin Fan, Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, 210029, China.
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Makaram NS, Ross LA, Keenan OJ, Magill M, Moran M, Scott CEH. Reliability of current classification systems for periprosthetic distal femur fractures. Injury 2022; 53:3430-3437. [PMID: 35948511 DOI: 10.1016/j.injury.2022.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study aims to determine which Periprosthetic Distal Femur Fracture (PDFF) classification system is the most reliable. The secondary aim was to determine which classification system correlated most accurately with the surgical management recommended and delivered. METHODS Between 2011 and 2019, 83 patients with 83 PDFFs that extended to the femoral component of a total knee arthroplasty (TKA) were retrospectively identified from a trauma database. Minimum follow-up was 1 year. Age, BMI, time from TKA, operative management, and Nottingham Hip Fracture Scores were collected, and AP and lateral radiographs used to classify all fractures using seven established classification systems by two observers blinded to management. In patients treated operatively (n = 69), preoperative radiographs were reviewed by two surgeons with expertise in trauma and knee revision who recommended fixation or distal femoral replacement (DFR) requirement. RESULTS Mean age was 80.7 years (SD9.4) and 50 (84.7%) were female. PDFFs occurred at a mean 9.5 years (SD5.2) after primary TKA. Mean follow-up was 3.8 years (SD2.9). Management was fixation in 47, DFR in 22 and non-operative for 14. The Fakler classification demonstrated highest interobserver reliability (ICC=0.948), followed by the Rorabeck (ICC=0.903), UCS (ICC=0.850) and Chen (ICC=0.906). The Neer classification demonstrated weakest agreement (ICC=0.633). Overall accuracy of predicting DFR requirement (as determined by two experts) was highest for the Fakler system (83.9%). Compared with actual management delivered the Rorabeck system was most accurate (94.1%). Multivariate regression demonstrated that the ultimate need for DFR (n = 22) was independently associated with medial comminution (HR 2.66 (1.12-6.35 95%CI), p = 0.027) and fractures distal to the anterior flange and posterior condyle of the femoral component (HR 2.45 (1.13-5.31), p = 0.024). CONCLUSION The Fakler classification showed highest interobserver agreement and was most accurately predictive of the management recommended by two experts. No classification system accurately predicted the fractures that required DFR, and none included medial comminution which was independently associated with DFR requirement. There remains a need for a PDFF classification system that reliably guides operative management of PDFFs.
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Affiliation(s)
- Navnit S Makaram
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom; The University of Edinburgh, Little France Crescent, United Kingdom.
| | - Lauren A Ross
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | - Oisin Jf Keenan
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | - Matthew Magill
- The University of Edinburgh, Little France Crescent, United Kingdom
| | - Matt Moran
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | - Chloe E H Scott
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom; The University of Edinburgh, Little France Crescent, United Kingdom
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Ponugoti N, Raghu A, Kosy JD, Magill H. A comparison of distal femoral replacement versus fixation in treating periprosthetic supracondylar femur fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022; 143:3335-3345. [PMID: 36088601 DOI: 10.1007/s00402-022-04603-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The treatment of periprosthetic femur fractures around a total knee replacement remains a technical challenge for the orthopedic surgeon. Management options include non-operative treatment, plate fixation, intramedullary nailing and distal femur replacement (DFR), with few studies comparing fixation with DFR. This is an up-to-date meta-analysis in the literature to directly compare clinical outcomes between fixation and distal femoral replacement in the treatment of supracondylar periprosthetic femur fractures. METHODS A stratified literature search of the Medline, EMBASE and Cochrane databases was performed. All studies in English language were searched from inception to July 2022. The search was performed with the following MeSH terms: Periprosthetic fracture AND ORIF OR Internal Fixation AND Distal Femur Replacement. The search was conducted using a predesigned search strategy where all eligible literature was critically appraised for methodological quality using the Cochrane collaboration tool. We included Level I, II and III studies comparing fixation with DFR in the treatment of periprosthetic supracondylar femur fractures. Data from eligible studies were extracted by two authors (NP and AR) and a table created which included author, year, sample size, mean age, measured parameters, follow-up period, fracture classification, length of stay (days), mortality rate, revision rate and complication rate. RESULTS The extracted data were pooled for meta-analysis using RevMan® v5.3.5 software (Nordic Cochrane Centre, Copenhagen, Denmark) and forest plots constructed. A p value < 0.05 was considered statistically significant and confidence intervals (CI) set to 95%. A total of six studies were included in the meta-analysis (n = 406). 153 patients underwent distal femur replacement and 253 patients underwent fixation with a mean follow-up time of 71.4 months. The results of this analysis suggest no statistically significant difference in measured outcomes. CONCLUSION The results of this meta-analysis suggest no proven statistically significant difference between DFR and fixation in terms of length of hospital stay, mortality rate, revision rate and complication rate for the treatment of periprosthetic supracondylar femur fractures. Further prospective randomized research may help to define the specific indications for each treatment option which must include fracture configuration. Early functional outcome and cost-effectiveness have yet to be evaluated in the available literature.
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Affiliation(s)
| | - Aashish Raghu
- East and North Hertfordshire NHS Trust, Stevenage, UK
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McMellen CJ, Romeo NM. Interprosthetic Femur Fractures: A Review Article. JBJS Rev 2022; 10:01874474-202209000-00004. [PMID: 36137069 DOI: 10.2106/jbjs.rvw.22.00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
➢ The prevalence of interprosthetic femur fractures (IFFs) is rising with the aging population and increased prevalence of total joint arthroplasty. ➢ IFFs have high rates of complications and high associated morbidity and mortality. ➢ The main treatment methods available for IFFs include plate fixation, intramedullary nailing, combined plate fixation and intramedullary nailing, and revision arthroplasty including partial and total femur replacement. ➢ There have been several proposed classification systems and at least 1 proposed treatment algorithm for IFFs; however, there is no consensus. ➢ Whichever treatment option is chosen, goals of surgery should include preservation of blood supply, restoration of length, alignment, rotation, and sufficient stabilization to allow for early mobilization.
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Affiliation(s)
- Christopher J McMellen
- MetroHealth Medical Center, Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Department of Orthopaedic Surgery, Cleveland, Ohio
| | - Nicholas M Romeo
- MetroHealth Medical Center, Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Galán-Olleros M, García-Coiradas J, Llanos S, Valle-Cruz J, Marco F. [Translated article] Fracture planning is easy: Development of a basic method of digital planning based on the traditional pencil and paper technique. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T328-T340. [DOI: 10.1016/j.recot.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
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Battut T, Argenson JN, Flecher X, Le Baron M. Comparison of morbidity-mortality and functional results between implant exchange and internal fixation by plate for periprosthetic femoral fracture in total knee arthroplasty: A 52-case series. Orthop Traumatol Surg Res 2022; 108:103293. [PMID: 35477035 DOI: 10.1016/j.otsr.2022.103293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 08/30/2021] [Accepted: 09/30/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Surgical options for periprosthetic femoral fracture in total knee arthroplasty (TKA) are controversial. The present retrospective study compared morbidity, mortality and functional results between implant exchange (group IE) and internal fixation by plate (group IF). The study hypothesis was that implant exchange does not give rise to more complications than plate fixation and that functional results are equivalent. METHODS Fifty-two femoral fractures in contact with a TKA implant were studied. The IE and IF groups (n 32 and 20, respectively), were comparable for age, gender and ASA score. Mean age was 80.5 years (range, 53-96 years). Morbidity and mortality were assessed on Clavien score; functional assessment used the KOOS questionnaire. RESULTS Mortality was 50% in group IF and 40% in group IE (p=0.4817). One patient was lost to follow-up. Complications were seen in 15 group IF patients (48.4%) versus 5 in group IE (26.3%) (p=0.14760), with infection in 5 (16.1%) and 2 patients (10.5%) respectively (p=0.69475). In both groups, 9 patients (i.e., 28.1% and 40% respectively) showed grade 2 complications (p=1). Revision surgery was performed in 8 grade 3b patients (25%) in the IF group and in 3 (15%) in the IE group (p=1). Mean KOOS score was 40 (range, 20-72) in IF and 65 (range, 50-93) in IE (p=0.0004). CONCLUSION Morbidity and mortality were comparable between implant exchange and plate fixation for periprosthetic femoral fracture in TKA. KOOS functional scores were better with implant exchange. Implant exchange may be suited to complex fracture with stable implant. LEVEL OF EVIDENCE IV, observational study.
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Affiliation(s)
- Thibault Battut
- Hôpital d'Instruction des Armées Laveran, 34, boulevard Laveran, 13013 Marseille, France.
| | - Jean-Noël Argenson
- Institut du Mouvement et de l'Appareil Locomoteur, Centre Hospitalo-Universitaire Sud, hôpital Sainte-Marguerite, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Xavier Flecher
- Institut du Mouvement et de l'Appareil Locomoteur, CHU Marseille Nord, Chemin des Bourrely, 13015 Marseille, France
| | - Marie Le Baron
- Institut du Mouvement et de l'Appareil Locomoteur, CHU Marseille Nord, Chemin des Bourrely, 13015 Marseille, France
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Shon O, Kim GB, On JW. Bone Hook Reduction Technique Combined with Lateral Parapatellar Arthrotomy for Periprosthetic Distal Femoral Fractures Following Total Knee Arthroplasty: A Technical Note. Orthop Surg 2022; 14:1902-1906. [PMID: 35733274 PMCID: PMC9363775 DOI: 10.1111/os.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To report a bone hook reduction technique combined with lateral parapatellar arthrotomy for periprosthetic distal femoral fractures following total knee arthroplasty (TKA). METHODS From April 2012 to June 2018, a total of 31 knees who underwent this technique for the treatment of periprosthetic distal femoral fractures following TKA were retrospectively reviewed. Through a lateral parapatellar arthrotomy, the vastus lateralis fascia was dissected from the muscle belly to allow anteromedial mobilization of the muscles. With direct visualization of the posteriorly angulated distal fragment, a bone hook was placed on the anterior flange of the femoral component. The hook was then elevated to correct the posteriorly angulated and shortened distal fragment. The coronal and sagittal alignments of the distal segment with the femoral shaft were confirmed using fluoroscopic images, and internal fixation was performed using an anatomically pre-contoured lateral locked plate. Once the overall length and sagittal plane alignment were restored, the plate was inserted via the previous articular approach. The plate was centered on the femur using anteroposterior and lateral fluoroscopy and then fixed. RESULTS A total of 28 patients underwent internal fixation using the bone hook reduction technique combined with lateral parapatellar arthrotomy for the treatment of periprosthetic distal femoral fractures following TKA. The average age at operation was 70.9 years (range, 62-83 years), and the average follow-up period was 17.5 months (range, 12-48.5 months). Fractures were classified as Su type I (13/28 [46.4%]), type II (11/28 [39.3%]), and type III (4/28 [14.3%]). Bone union was confirmed radiographically in all patients. CONCLUSION The bone hook reduction technique is a simple and effective method to reduce the distal fragment in periprosthetic distal femoral fractures following TKA.
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Affiliation(s)
- Oog‐Jin Shon
- Department of Orthopaedic SurgeryYeungnam University College of Medicine, Yeungnam University Medical CenterDaeguRepublic of Korea
| | - Gi Beom Kim
- Department of Orthopaedic SurgeryYeungnam University College of Medicine, Yeungnam University Medical CenterDaeguRepublic of Korea
| | - Je Won On
- Department of Orthopaedic SurgeryYeungnam University College of Medicine, Yeungnam University Medical CenterDaeguRepublic of Korea
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Distal femoral replacement or internal fixation for management of periprosthetic distal femur fractures: A systematic review. Knee 2022; 37:121-131. [PMID: 35772245 DOI: 10.1016/j.knee.2022.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 06/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The number of periprosthetic fractures above a total knee arthroplasty continues to increase. These fractures are associated with a high risk of morbidity and mortality. Techniques for addressing these fractures include open reduction internal fixation (ORIF) and revision arthroplasty, including distal femoral replacement (DFR). The primary aim of this review is to compare mortality and reoperation rates between ORIF and DFR when used to treat periprosthetic distal femur fractures. METHODS A systematic review including MEDLINE, Embase and Cochrane Library databases was completed from inception to April 10, 2021. Studies including a comparator cohort were meta-analyzed. RESULTS Fourteen studies were identified for inclusion, of which, five had sufficient homogeneity for inclusion in a meta-analysis. 30-day and 2-year mortality was 4.1% and 14.6% in the DFR group. There was no statistically significant difference between ORIF and DFR (log Odds-Ratio (OR) = -0.14, 95 %CI: -0.77 to 0.50). The reoperation rate in the DFR group was 9.3% versus 14.8% for ORIF, with no difference between groups (log OR = 0.10, 95 %CI: -0.59 to 0.79). There was no difference in rates of deep infection (log OR = 0.22, 95 %CI: -0.83 to 1.28). Direct comparison of functional outcomes was not possible, though did not appear significant. CONCLUSION DFR in the setting of periprosthetic distal femur fractures is equivalent to ORIF with respect to mortality and reoperation rate and thus a safe and reliable treatment strategy. DFR may be more reliable in complex fracture patterns where the ability to obtain adequate fixation is difficult.
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Kaufman MW, Rascoe AS, Hii JL, Thom ML, Levine AD, Wilber RG, Hirschfeld AG, Romeo NM, Wera GD. Comparable Outcomes Between Native and Periprosthetic Fractures of the Distal Femur. J Knee Surg 2022. [PMID: 35820430 DOI: 10.1055/s-0042-1749604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite the rising prevalence of arthroplasty and aging population, limited data exist regarding differences in periprosthetic fracture clinical outcomes compared with native counterparts. This study compares differences in hospital treatment, morbidity, and mortality associated with periprosthetic distal femur fractures at an urban level 1 trauma center. We retrospectively reviewed all adult AO/OTA type 33 fractures (526) that presented to our institution between 2009 and 2018. In total, 54 native and 54 periprosthetic fractures were matched by age and gender. We recorded demographics, operative measures, length of stay (LOS), discharge disposition, and mortality. We used McNemar's and paired t-tests for analysis where appropriate (p < 0.05) (IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY; IBM Corp.). The average age at injury was 74 years ± 12 (native) compared with 73 years ± 12 (periprosthetic). After 1:1 matching, the groups had similar body mass index (31.01 vs. 32.98, p = 0.966 for native and periprosthetic, respectively) and mechanisms of injury with 38 native and 44 periprosthetic (p = 0.198) fractures from low-energy falls. Both groups had 51/54 fractures managed with open reduction internal fixation with a locking plate. The remaining were managed via amputation or intramedullary nail fixation. Mean operative time (144 minutes (±64) vs. 132 minutes (±62), p = 0.96) and estimated blood loss (319 mL (±362) vs. 289 mL (±231), p = 0.44) were comparable between the native and periprosthetic groups, respectively. LOS: 9 days ± 7 (native) versus 7 days ± 5 (periprosthetic, p = 0.31); discharge disposition (to skilled nursing facility/rehab): n = 47 (native) versus n = 43 (periprosthetic, p = 0.61); and mortality: n = 6 (native) versus n = 8 (periprosthetic, p = 0.55). No significant differences were observed. We found no statistical differences in morbidity and mortality in periprosthetic distal femur fractures treated over 10 years at a level 1 trauma center. Native and periprosthetic AO/OTA type 33 distal femur fractures are serious injuries with similar outcomes at a level 1 trauma center.
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Affiliation(s)
- Matthew W Kaufman
- Department of Orthopedic Surgery, Case Western Reserve University School of Medicine Cleveland, Ohio
| | - Alexander S Rascoe
- Department of Orthopedic Surgery, Case Western Reserve University School of Medicine Cleveland, Ohio
| | - Jeffrey L Hii
- Department of Orthopedic Surgery, Case Western Reserve University School of Medicine Cleveland, Ohio
| | - Mitchell L Thom
- Department of Orthopedic Surgery, Case Western Reserve University School of Medicine Cleveland, Ohio
| | - Ari D Levine
- Department of Orthopedic Surgery, Case Western Reserve University School of Medicine Cleveland, Ohio.,Department of Orthopedic Surgery, MetroHealth Medical Center, Cleveland, Ohio
| | - Roger G Wilber
- Department of Orthopedic Surgery, Case Western Reserve University School of Medicine Cleveland, Ohio.,Department of Orthopedic Surgery, MetroHealth Medical Center, Cleveland, Ohio
| | - Adam G Hirschfeld
- Department of Orthopedic Surgery, Case Western Reserve University School of Medicine Cleveland, Ohio.,Department of Orthopedic Surgery, MetroHealth Medical Center, Cleveland, Ohio
| | - Nicholas M Romeo
- Department of Orthopedic Surgery, Case Western Reserve University School of Medicine Cleveland, Ohio.,Department of Orthopedic Surgery, MetroHealth Medical Center, Cleveland, Ohio
| | - Glenn D Wera
- Department of Orthopedic Surgery, Case Western Reserve University School of Medicine Cleveland, Ohio.,Department of Orthopedic Surgery, MetroHealth Medical Center, Cleveland, Ohio
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Kim JH, Kim KI, Park KC, Shon OJ, Sim JA, Kim GB. New Classification for Periprosthetic Distal Femoral Fractures Based on Locked-Plate Fixation Following Total Knee Arthroplasty: A Multicenter Study. J Arthroplasty 2022; 37:966-973. [PMID: 35121090 DOI: 10.1016/j.arth.2022.01.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to establish a new classification using locked-plate fixation for periprosthetic distal femoral fracture (PDFF) following total knee arthroplasty (TKA) and to determine when dual locked-plate fixation is necessary through defining this classification. METHODS One-hundred fifteen consecutive PDFFs that underwent operative treatment were reviewed from 2011 to 2019 with minimum 1-year follow-up. Most PDFFs were fixed with single or dual locked-plate fixations using the minimally invasive plate osteosynthesis technique. Based on preoperative radiographs, PDFFs were classified according to the level of main fracture line relative to the anterior flange of femoral component: type I and II, main fracture line located proximal and distal to the anterior flange; and type III, component instability regardless of fracture line requiring revisional TKA. Furthermore, type II fractures were subclassified based on the direction of fracture beak as follows: type IIL, lateral-beak; type IIM, medial-beak. The incidence, treatment methods, and complications were analyzed according to the classification. RESULTS Incidences of type I, IIL, IIM, and III were 64.4%, 8.7%, 24.3%, and 2.6%, respectively. Meanwhile, most PDFFs in type I and II were treated with lateral single locked-plate fixations, except for type IIM, which was treated with either single or dual locked-plate fixations. Overall complications were significantly higher in type II (28.9%) than in type I (10.8%, P = .019). In type IIM, bone union-related complications were significantly higher in single locked-plate fixation (50.0%) than in dual locked-plate fixation (5.6%; P = .013). CONCLUSION The new classification provides practical and obvious strategies for the treatment of PDFF following TKA using locked-plate fixation. For type IIM fracture, dual plate fixation is necessary to prevent fixation failure or nonunion.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea; Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ki Chul Park
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Gyeonggi-do, Korea
| | - Oog-Jin Shon
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Jae Ang Sim
- Department of Orthopaedics Surgery, Gachon University College of Medicine, Incheon, Korea
| | - Gi Beom Kim
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
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Finzi SS, Berdini M, Carola D, Lattanzi G, Orabona G, Pascarella R, Gigante AP, Cerbasi S. Treatment of periprosthetic supracondylar fractures after CR total knee arthroplasty with retrograde intramedullary nailing in an elderly population: a long term evaluation. Orthop Rev (Pavia) 2022; 14:33978. [DOI: 10.52965/001c.33978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 11/06/2022] Open
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Pujol O, Joshi-Jubert N, Nuñez JH, Pijoan J, Castellet E, Minguell J. High reoperation and mortality rate after distal femoral replacement for periprosthetic knee fracture in the elderly. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:911-918. [PMID: 35182239 DOI: 10.1007/s00590-022-03225-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze the outcomes of elderly patients with periprosthetic fractures around the knee operated on with a distal femur replacement (DFR). METHODS We performed a retrospective case series study of eleven elderly patients who underwent DFR due to a periprosthetic fracture. Mean follow-up was 30.1 months (SD 28.1). Demographic, clinical and radiological data were reviewed. A descriptive analysis and a study of survival were conducted. Then, a comparative analysis between the patients who needed reoperation and did not need reoperation, and the patients who died and the patients who were alive during the follow-up was performed. RESULTS Mean age was 77.1 years (SD 13.9). Reoperation rate was 36%, being infection the most common complication (27%). The risk of reoperation increased with a longer time between fracture and surgery. The 36.4% of patients died during the follow-up. Older age, need of blood transfusion and need of early reoperation were related to a higher risk of mortality. CONCLUSION DFR could be a valuable option for knee periprosthetic fractures in elderly patients. However, surgeons should be aware of the high reoperation and mortality rate.
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Affiliation(s)
- Oriol Pujol
- Knee Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain. .,Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Nayana Joshi-Jubert
- Knee Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jorge H Nuñez
- Knee Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Joan Pijoan
- Knee Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Enric Castellet
- Knee Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Joan Minguell
- Knee Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
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To Fix or Revise: Differences in Periprosthetic Distal Femur Fracture Management Between Trauma and Arthroplasty Surgeons. J Am Acad Orthop Surg 2022; 30:e17-e24. [PMID: 34288890 DOI: 10.5435/jaaos-d-20-00968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 05/23/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This study sought to determine the effect of trauma fellowship training on the surgical decision to fix or revise to distal femoral replacement in periprosthetic distal femur fractures. METHODS An anonymous online survey including nine cases of geriatric periprosthetic distal femur fractures was distributed through the Orthopaedic Trauma Association website. Respondents were asked whether they would recommend fixation or revision to distal femoral replacement. Fractures were classified by the location relative to the anterior flange (proximal or distal) and the presence or absence of comminution. Recommendations were compared between type of fellowship completed (trauma, arthroplasty, or both), practice setting, and number of periprosthetic distal femur fractures treated monthly. RESULTS One hundred fifty-one surgeon survey responses were included. Completion of a trauma fellowship was associated with a higher likelihood of recommending fixation for any periprosthetic distal femur fracture compared with arthroplasty training (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.97 to 3.29; P < 0.0001). Disagreement was significant for comminuted proximal (OR 6.90, 95% CI 3.24 to 14.68; P < 0.0001), simple distal (OR 20.90, 95% CI 6.41 to 67.71; P < 0.001), and comminuted distal fractures (OR 2.47, 95% CI 1.66 to 3.68; P < 0.0001). Dual fellowship-trained surgeons were less likely to recommend fixation than surgeons who completed a trauma fellowship alone (OR 0.60, 95% CI 0.39 to 0.93; P = 0.027) and more likely to recommend fixation than surgeons who completed an arthroplasty fellowship alone (OR 1.70, 95% CI 1.13 to 2.63; P = 0.012). Surgeons who treat three or more periprosthetic distal femur fractures monthly showed a significant preference for fracture fixation compared with lower volume surgeons (OR 2.45, 95% CI 1.62 to 3.68; P < 0.0001). DISCUSSION Fellowship-trained trauma surgeons show a notable preference for fracture fixation over distal femoral replacement for periprosthetic distal femur fractures, as compared with arthroplasty-trained surgeons. Additional research is needed to clarify surgical indications that maximize outcomes for these injuries.
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Sukhonthamarn K, Strony JT, Patel UJ, Brown SA, Nazarian DG, Parvizi J, Klein GR. Distal Femoral Replacement and Periprosthetic Joint Infection After Non-Oncological Reconstruction: A Retrospective Analysis. J Arthroplasty 2021; 36:3959-3965. [PMID: 34518056 DOI: 10.1016/j.arth.2021.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Distal femoral replacement (DFR) is commonly used to manage massive bone loss around the knee arising from aseptic loosening, periprosthetic joint infection (PJI), and distal femoral fractures. A number of studies report the outcome of DFR with considerable variation in long-term survivorship. This study investigated the outcome of DFR for patients with aseptic failures, fractures, and PJI. METHODS A retrospective review of 182 patients who underwent DFR for non-oncological indications between 2002 and 2018 was conducted. Data collected included the following: indication, postoperative complications, reoperation, revision, and follow-up. Implant survivorship with Kaplan-Meier curves along with a log-rank test for different preoperative indications was performed. A Cox regression model was used to evaluate the risk of revision. RESULTS The overall postoperative complication rate was very high at 36%. The most common complication was PJI (17%). The rate of reoperation for any cause was 29.7%, and the revision rate was 13.7%. The most common cause of re-revision was PJI (7.1%). Revision-free survivorship of the DFR implant was 91.6% at 1 year, 87.9% at 2 years, 82.5% at 5 years, and 73.4% at 10 years. Patients who had a prior-PJI had the lowest survivorship compared to patients undergoing DFR for management of periprosthetic fracture and mechanical loosening. Additionally, the prior-PJI group was at a fourfold increased risk of postoperative PJI compared to the aseptic group. CONCLUSION DFR is a valuable reconstructive option for patients with massive bone loss around the knee. However, patients undergoing DFR are at high risk of complications, reoperations, and failure.
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Affiliation(s)
- Kamolsak Sukhonthamarn
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - John T Strony
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Urvi J Patel
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Scot A Brown
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - David G Nazarian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Gregg R Klein
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Rubinger L, Khalik HA, Gazendam A, Wolfstadt J, Khoshbin A, Tushinski D, Johal H. Very Distal Femoral Periprosthetic Fractures: Replacement Versus Fixation: A Systematic Review. J Orthop Trauma 2021; 35:573-583. [PMID: 33993176 DOI: 10.1097/bot.0000000000002080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To synthesize all-cause reoperations and complications data as well as secondary clinical and functional outcomes, after the management of very distal femur periprosthetic fractures (vDFPFs) in a geriatric patient population with either a distal femoral locking plate (DFLP) or distal femoral replacement (DFR). DATA SOURCES MEDLINE, Embase, and Web of Science were searched for English language articles from inception to March 16, 2020, in accordance to the PRISMA guidelines. STUDY SELECTION Studies reporting the management of vDFPFs in adults older than 65 years with either a DFLP or DFR were included. To ensure this review solely focused on very distal femoral periprosthetic fractures, only fractures of the following classifications were included: (1) Lewis and Rorabeck type II or III, (2) Su and Associates' Classification of Supracondylar Fractures of the Distal Femur type III, (3) Backstein et al type F2, and/or (4) Kim et al type II or III. DATA EXTRACTION Three reviewers independently extracted data from the included studies. Study validity was assessed using the methodological index for nonrandomized studies (MINORS), a quality assessment tool for nonrandomized controlled studies in surgery. DATA SYNTHESIS Twenty-five studies with 649 vDFPFs were included for analysis. There were 440 knees in the DFLP group (mean age range: 65.9-88.3 years) and 209 knees in the DFR group (mean age range: 71.0-84.8 years). Because of the literature's heterogeneity, the data were qualitatively synthesized. CONCLUSIONS vDFPFs in the elderly treated with DFR underwent fewer reoperations relative to DFLP (0%-45% vs. 0%-77%, respectively). Time to weight-bearing was observably shorter in DFR studies relative to DFLP studies. Functional outcomes and postoperative range of motion indicated a trend for DFLP knees to outperform DFR knees. Future research should include prospective studies and cost-effectiveness evaluations to better understand the utility of DFR for these fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Luc Rubinger
- Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada
| | - Hassaan Abdel Khalik
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada
| | - Jesse Wolfstadt
- Granovsky Gluskin Division of Orthopedic Surgery, Sinai Health System, University of Toronto, Toronto, ON, Canada; and
| | - Amir Khoshbin
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Daniel Tushinski
- Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada
| | - Herman Johal
- Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada
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Atalay IB, Ozturk R, Yapar A, Karakoc Y, Eksioglu MF. Outcomes of the Surgical Treatment of Periprosthetic Fractures Around the Knee with Locking Plates: A Single Centre Experience. Malays Orthop J 2021; 15:1-7. [PMID: 34966488 PMCID: PMC8667242 DOI: 10.5704/moj.2111.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/06/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Surgical treatment options for periprosthetic fractures (PPF) include internal fixation with plate, intramedullary nailing and revision arthroplasty. We aimed at evaluating the surgical outcomes of patients who we had treated PPF with locking compression plates (LCP). MATERIALS AND METHODS Twenty patients with PPF after primary total knee arthroplasty (TKA) between 2009 and 2016 were included in to the study. Knee Society Knee Scoring System (KSKSS) was used in the evaluation of radiologic and functional outcomes. There were periprosthetic supracondylar femoral fractures in 15 patients, and that of tibial fractures in 5 patients. For internal fixation, locking compression plate was preferred. RESULTS The mean age was 69 (range 61 to 78) years and the mean follow-up period was 72.25 (range 24 to 110) months. Union was achieved by 15.8 weeks in all the cases. Superficial infection and implant fracture were each seen in two patients. Revision operations were done to those patients with implant fracture. Mean KSKSS was 81.4 (75-87) and the mean functional score was 78.75 (75-85). Degenerative osteoarthritis patients were found to have higher age values than post-traumatic osteoarthritis patients (p = 0.001). When the union times were compared, it was found that the degenerative osteoarthritis patient group had a significantly shorter union than the post-traumatic osteoarthritis patient group (p = 0.036). CONCLUSION Internal fixation with LCP is an effective treatment method in managing of PPF for patients with good bone stock. Rigid fixation should be done with the right surgical technique and an early movement must be initiated so that a good function can be achieved.
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Affiliation(s)
- IB Atalay
- Department of Orthopaedics and Traumatology, Dr Abdurrahman Yurtaslan Onkoloji Egitim ve Arastirma Hastanesi, Ankara, Turkey
| | - R Ozturk
- Department of Orthopaedics and Traumatology, Dr Abdurrahman Yurtaslan Onkoloji Egitim ve Arastirma Hastanesi, Ankara, Turkey
| | - A Yapar
- Department of Orthopaedics and Traumatology, Dr Abdurrahman Yurtaslan Onkoloji Egitim ve Arastirma Hastanesi, Ankara, Turkey
| | - Y Karakoc
- Department of Orthopaedics and Traumatology, Dr Abdurrahman Yurtaslan Onkoloji Egitim ve Arastirma Hastanesi, Ankara, Turkey
| | - MF Eksioglu
- Department of Orthopaedics and Traumatology, Dr Abdurrahman Yurtaslan Onkoloji Egitim ve Arastirma Hastanesi, Ankara, Turkey
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Smolle MA, Hörlesberger N, Maurer-Ertl W, Puchwein P, Seibert FJ, Leithner A. Periprosthetic fractures of hip and knee-A morbidity and mortality analysis. Injury 2021; 52:3483-3488. [PMID: 33536128 DOI: 10.1016/j.injury.2021.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Periprosthetic fractures (PPF) following total knee (TKA) and hip arthroplasty (THA) have become more common over the years. The aim of the present study was to assess morbidity and mortality following surgery for PPF of hip and knee. PATIENTS AND METHODS Altogether, 124 patients (mean age: 77 years; 77.4% female) with PPF of the hip (n=97) and knee (n=27), treated between 2005 and 2017 at a level-1 trauma centre, were retrospectively included. In order to assess risk factors for postoperative morbidity, Fine and Gray's model was used to compensate for death as the competing event. Risk factors for mortality were estimated with uni- and multivariate Cox-regression models. RESULTS Vancouver B2 fractures were most common (n=39; 42.4%), followed by B1 fractures (n=23; 25.0%). Lewis-Rorabeck Type I fractures (n=14; 51.9%) were most frequent in PPF of the knee. Overall complication rates were 44.0% and 29.9% for PPF of the knee and hip, respectively, with three patients having both early and late complications, 25 patients developing early complications and 19 patients undergoing surgery for implant-related, late complications. In the multivariate Fine and Gray model, advanced patient age (HR: 0.956; 95%CI: 0.922-0.991; p=0.014) and prosthesis exchange (vs. ORIF; HR: 0.242, 95%CI: 0.068-0.859; p=0.028) were associated with lower risk of implant-related complications, irrespective of gender (p=0.450) and a surgical delay > 2 days (p=0.411). One- and 5-year overall survival-rates were 97.9% and 93.1%, respectively. Gender, type of fixation (ORIF vs. prosthesis exchange), surgical delay > 2 days, BMI and age at surgery were neither in the univariate, nor multivariate Cox-regression model associated with an increased mortality rate. CONCLUSION Postoperative morbidity caused by implant-related complications is higher in younger patients and those receiving ORIF. With the statistical approach used, potential underestimation of actual complication rates may have been avoided, taking into account death as the competing event. Despite being based on a retrospective, heterogenous patient collective treated at a level-1 trauma centre, our results indicate that careful planning of the surgical procedure beyond 2 days, taking into consideration both patient's age and activity level, has no negative effect on patient outcome.
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Affiliation(s)
- Maria A Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz 8036, Austria.
| | - Nina Hörlesberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz 8036, Austria.
| | - Werner Maurer-Ertl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz 8036, Austria.
| | - Paul Puchwein
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz 8036, Austria.
| | - Franz-Josef Seibert
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz 8036, Austria.
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz 8036, Austria.
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Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation. J Clin Med 2021; 10:jcm10214926. [PMID: 34768444 PMCID: PMC8584452 DOI: 10.3390/jcm10214926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022] Open
Abstract
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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Galán-Olleros M, García-Coiradas J, Llanos S, Valle-Cruz JA, Marco F. Fracture planning is easy: Development of a basic method of digital planning based on the traditional pencil and paper technique. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:328-340. [PMID: 34366259 DOI: 10.1016/j.recot.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/30/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Preoperative planning constitutes a fundamental tool in the management of fractures; however, its practical application is far from the desired, perhaps due to the absence of a basic and simple method, adapted to the current times. We describe a digital planning method, halfway between the traditional and the technological, which preserves its educational essence, allows the understanding of the fracture and the individualization of the osteosynthesis. MATERIAL AND METHODS After the initial analysis of the fracture and the patient's characteristics, different measurements are made on X-ray and CT images with a digital medical imaging software. These images are then copied into a presentation program (Microsoft® PowerPoint or Keynote ©Apple Inc.), in which the main fragments and fracture lines are traced with the computer pointer. These are subsequently moved into a reduced position and the implants for internal fixation are graphically represented together with a guide of the surgical strategy. RESULTS We show 4 cases of different types of fractures operated through reduction and osteosynthesis after preoperative planning according to the described method. The basic points for the surgical planning, logistics, tactics and postoperative radiological results of each case are detailed. CONCLUSIONS Despite rise of advanced planning software, traditional paper and pencil methods are still fundamental, even more so for the trauma surgeon in training. The digital planning method described is very appropriate for this purpose, as it combines the advantages of both methods: simplicity, accessibility, quickness, low-cost, reproducibility, educational character, efficiency and possibility of simulation, corrections and reuse of cases.
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Affiliation(s)
- M Galán-Olleros
- Unidad de Traumatología y Politraumatizados, Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico Universitario San Carlos, Madrid, España.
| | - J García-Coiradas
- Unidad de Traumatología y Politraumatizados, Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico Universitario San Carlos, Madrid, España
| | - S Llanos
- Unidad de Traumatología y Politraumatizados, Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico Universitario San Carlos, Madrid, España
| | - J A Valle-Cruz
- Unidad de Traumatología y Politraumatizados, Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico Universitario San Carlos, Madrid, España
| | - F Marco
- Unidad de Traumatología y Politraumatizados, Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico Universitario San Carlos, Madrid, España; Departamento de Cirugía, Facultad de Medicina de la Universidad Complutense de Madrid, Madrid, España
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