J Korean Orthop Assoc.  2021 Feb;56(1):26-33. 10.4055/jkoa.2021.56.1.26.

Dual Plate Fixation for Periprosthetic Femur Fracture after Total Knee Arthroplasty

• Kim DH
• Cha DH
• Ko KY

• KMID: 2512893
• DOI: http://doi.org/10.4055/jkoa.2021.56.1.26

Abstract

Purpose
This study evaluated the results of dual plate fixation for periprosthetic femur fracture after total knee arthroplasty (TKA).
Materials and Methods
From October 2007 to February 2013, 23 cases of periprosthetic femur fracture after TKA were treated at the author’s hospital. There were 13 cases of fixation using a medial and lateral dual plate when the stability of the fracture site could not be achieved by one side fixation with a follow-up of more than one year. The cases included no loosening of the femoral component in fractures that were categorized as Lewis–Rorabeck classification II and supracondylar comminuted fractures and elongation of the fracture line to the lateral epicondyle of the femur or stem in the medullary canal. The mean age was 72 years (65–82 years), and 11 cases were female. Three cases had a stem due to revision. The mean bone marrow density was -3.2 (-1.7 to -4.4), and the mean period from primary TKA to periprosthetic fractures was 28 months (1–108 months). The mean follow-up period was 23 months (12–65 months). The medial fracture site was first exposed via the subvastus approach. Second, the supplementary plate was fixed on the lateral side of the fracture using a minimally invasive plate osteosynthesis technique. The average union time, complications, and Hospital for Special Surgery Knee Score (HSS) at the last follow-up were evaluated.
Results
The mean union time was 17.4 weeks (7–40 weeks). Two cases showed delayed bone union and nonunion occurred in one case, in whom bone union was achieved three months later after re-fixation using a dual plate with an autogenous bone graft. The mean varusvalgus angulation was 1.67 degrees (-1.2–4.9 degrees), and the mean anterior-posterior angulation was 2.86 degrees (0–4.9 degrees) at the last follow-up. The mean knee range of motion was 90 degrees, and the HSS score was 85 points (70–95 points) at the last follow-up.
Conclusion
Dual plate fixation for periprosthetic femur fractures that had not achieved stability by one side plate fixation after TKA showed a good clinical result that allowed early rehabilitation.

Keyword

knee joint; periprosthetic fractures; dual plate