Clin Orthop Surg.  2018 Jun;10(2):174-180. 10.4055/cios.2018.10.2.174.

Comparing Outcomes of Tumor Prosthesis Revision and Locking Plate Fixation in Supracondylar Femoral Periprosthetic Fractures

• Gan G
• Teo YH
• Kwek EB

• KMID: 2411742
• DOI: http://doi.org/10.4055/cios.2018.10.2.174

Abstract

BACKGROUND
Periprosthetic fractures around a total knee replacement (TKR) can be complex and difficult to manage, requiring the surgical expertise of the trauma and arthroplasty surgeon. There are a number of treatment modalities available, each with their own merits and limitations. As data on tumor prosthesis revision in periprosthetic fractures is sparse, this study aims to evaluate the results of revision using a tumor prosthesis and compare them with those of fixation using a locking plate in periprosthetic fractures after TKR.
METHODS
This is a retrospective study of 15 patients who underwent either tumor prosthesis revision (n = 7) or locking plate fixation (n = 8) for supracondylar femoral periprosthetic fractures in our hospital from 2009 and 2014. The mean follow-up time for these patients was 44 months. This study's main outcome measures were pain relief, return to premorbid ambulatory function, and complications.
RESULTS
The revision and fixation groups saw five versus three patients achieve pain relief (71.4% vs. 37.5%, p = 0.315), and two versus four patients return to their premorbid ambulatory function (28.6% vs. 50%, p = 0.608) at the follow-up, respectively. The mean time to weight-bearing in the revision group and fixation group was 2.9 days and 18.9 weeks, respectively (p = 0.001). There were eight complications seen in the revision group with none requiring reoperation; there were five complications seen in the fixation group, and two required reoperation.
CONCLUSIONS
The results of revision TKR using a tumor prosthesis were comparable to those of fixation using a locking plate in periprosthetic fractures after TKR. Tumor prosthesis revision may be considered as a viable alternative to locking plate fixation when indicated.

Keyword

Prosthesis; Plate; Femoral; Periprosthetic fractures; Total knee replacement

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Knee
Follow-Up Studies
Humans
Outcome Assessment (Health Care)
Periprosthetic Fractures*
Prostheses and Implants*
Reoperation
Retrospective Studies
Weight-Bearing

Figure

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  Fig. 1 (A) Radiographs of a left supracondylar femoral periprosthetic fracture (Rorabeck type 3) requiring revision in the anteroposterior view (left) and lateral view (right). (B) Radiographs of a left supracondylar femoral periprosthetic fracture treated with tumor prosthesis revision 1 month postoperatively in the anteroposterior view (left) and lateral view (right).

• 

  Fig. 2 (A) Radiographs of a left comminuted supracondylar femoral periprosthetic fracture (Rorabeck type 2) with good bone stock amenable to fixation in the anteroposterior view (left) and lateral view (right). (B) Radiographs of the left comminuted supracondylar femoral periprosthetic fracture treated with locking plate fixation on postoperative day 1 in the anteroposterior view (left) and lateral view (right). (C) Bony union on 21-month postoperative anteroposterior (left) and lateral (right) radiographs.

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