Clin Orthop Surg.  2013 Jun;5(2):124-128. 10.4055/cios.2013.5.2.124.

The Outcome and Complications of the Locked Plating Management for the Periprosthetic Distal Femur Fractures after a Total Knee Arthroplasty

• Gavaskar A
• Tummala NC
• Subramanian M

• KMID: 1705533
• DOI: http://doi.org/10.4055/cios.2013.5.2.124

Abstract

BACKGROUND
The osteosynthesis of the periprosthetic fractures following a total knee arthroplasty (TKA) can be technically difficult with the relatively small satisfactory outcomes and the high complication rates. The purpose of the study is to analyze the mid-term radiological and functional outcomes following the locked plating of the distal femur periprosthetic fractures after a TKA.
METHODS
Records of 20 patients with a periprosthetic distal femur fracture following TKA treated by the locked plate osteosynthesis were retrospectively evaluated. The union rate, complications and functional outcome measures were analyzed.
RESULTS
Successful union was achieved in 18 of the 19 patients available for the follow-up. The mean follow-up was 39 +/- 10 months. Significant reductions (p < 0.05) in the range of motion and Western Ontario and McMaster Universities Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were evident in the follow-up. Secondary procedures were required in 5 patients to address the delay in union and the reduced knee range of motion. The osteosynthesis failed in 1 patient who underwent a revision TKA.
CONCLUSIONS
The satisfactory union rates can be achieved with the locked plate osteosynthesis in the periprosthetic distal femur fractures after TKA. Prolonged rehabilitation coupled with the un-modifiable risk factors can decrease the activity and satisfaction levels, which can significantly alter the functional outcome.

Keyword

Total knee arthroplasty; Periprosthetic fractures; Locked plating; Distal femur fractures; Osteosynthesis

MeSH Terms

Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee/*adverse effects
Female
Femoral Fractures/*etiology/radiography
Fracture Fixation, Internal/*adverse effects
Humans
Male
Osteoporosis/epidemiology
Periprosthetic Fractures/*etiology/radiography
Postoperative Complications/etiology
Range of Motion, Articular
Retrospective Studies
Risk Factors
Treatment Outcome

Figure

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  Fig. 1 A type II distal femur fracture treated by minimally invasive plate osteosynthesis using a 4.5 mm distal femur locked plate. Follow-up radiographs show union and satisfactory alignment.

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  Fig. 2 Nonunion of a type II distal femur fracture revised with a constrained total knee arthroplasty due to distal femur bone loss and the resultant instability.

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