J Korean Orthop Assoc.  2014 Dec;49(6):446-453. 10.4055/jkoa.2014.49.6.446.

The Result of Treatment of Femoral Periprosthetic Fractures after Total Knee Arthroplasty

• Kim JB
• Song IS
• Sun DH
• Choi H

• KMID: 2185158
• DOI: http://doi.org/10.4055/jkoa.2014.49.6.446

Abstract

PURPOSE
We assessed and compared the clinical and radiologic outcomes of treatment in periprosthetic fractures of the femur after total knee arthroplasty.
MATERIALS AND METHODS
We compared 22 knees, 22 patients of femoral periprosthetic fractures which had been fixed with absolute stabilization such as plate or screw fixation in 16 cases (group A), and with relative stabilization such as retrograde intramedullary nailing or Ender nailing in six cases (group B) from November 2004 to March 2013; the mean follow-up period was 51.9 months.
RESULTS
The mean tibio femoral angle and the mean mechanical axis showed statistically significant change in group B, between before fracture and last follow-up. The mean bone union time and the mean hospital for special surgery score were not significantly different between group A and B. Nonunion was demonstrated in one case in each group, malunion was demonstrated in one case in group B.
CONCLUSION
In the treatment of periprosthetic fractures of the femur after total knee arthroplasty, absolute stabilization had an advantage for regain of limb alignment. Among the complications, more cases of refracture and infection were observed in the absolute stabilization group, while more cases of nonunion and malunion were observed in the relative stabilization group.

Keyword

total knee replacement; internal fixators

MeSH Terms

Arthroplasty*
Arthroplasty, Replacement, Knee
Axis, Cervical Vertebra
Extremities
Femur
Follow-Up Studies
Fracture Fixation, Intramedullary
Humans
Internal Fixators
Knee*
Periprosthetic Fractures*

Figure

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  Figure 1 (A) These preoperative radiographs of a 76-year-old female patient show a Rorabeck type II periprosthetic femoral fracture. (B) Postoperative radiographs show a well reduced fracture line using a dual locking compression plate. (C) Twelve-months follow-up radiographs demonstrate a well healed fracture and good alignment.

• 

  Figure 2 (A) These preoperative radiographs of a 78-year-old female patient shows a Rorabeck type II periprosthetic femoral fracture due to anterior notching. (B) Postoperative radiographs show good reduction of the fracture site using a retrograde intramedullary nail. (C) Fifteen-months follow-up radiographs demonstrate successful bone union with metal removal, but remaining anterior notching and malalignment.

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