1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
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: 0] [Impact Index Per Article: 0] [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.
Collapse
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
| |
Collapse
|
4
|
Ross LA, Keenan OJF, Magill M, Brennan CM, Clement ND, Moran M, Patton JT, Scott CEH. Management of low periprosthetic distal femoral fractures. Bone Joint J 2021; 103-B:635-643. [PMID: 33789473 DOI: 10.1302/0301-620x.103b4.bjj-2020-1710.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS Debate continues regarding the optimum management of periprosthetic distal femoral fractures (PDFFs). This study aims to determine which operative treatment is associated with the lowest perioperative morbidity and mortality when treating low (Su type II and III) PDFFs comparing lateral locking plate fixation (LLP-ORIF) or distal femoral arthroplasty (DFA). METHODS This was a retrospective cohort study of 60 consecutive unilateral (PDFFs) of Su types II (40/60) and III (20/60) in patients aged ≥ 60 years: 33 underwent LLP-ORIF (mean age 81.3 years (SD 10.5), BMI 26.7 (SD 5.5); 29/33 female); and 27 underwent DFA (mean age 78.8 years (SD 8.3); BMI 26.7 (SD 6.6); 19/27 female). The primary outcome measure was reoperation. Secondary outcomes included perioperative complications, calculated blood loss, transfusion requirements, functional mobility status, length of acute hospital stay, discharge destination and mortality. Kaplan-Meier survival analysis was performed. Cox multivariate regression analysis was performed to identify risk factors for reoperation after LLP-ORIF. RESULTS Follow-up was at mean 3.8 years (1.0 to 10.4). One-year mortality was 13% (8/60). Reoperation was more common following LLP-ORIF: 7/33 versus 0/27 (p = 0.008). Five-year survival for reoperation was significantly better following DFA; 100% compared to 70.8% (95% confidence interval (CI) 51.8% to 89.8%, p = 0.006). There was no difference for the endpoint mechanical failure (including radiological loosening); ORIF 74.5% (56.3 to 92.7), and DFA 78.2% (52.3 to 100, p = 0.182). Reoperation following LLP-ORIF was independently associated with medial comminution; hazard ratio (HR) 10.7 (1.45 to 79.5, p = 0.020). Anatomical reduction was protective against reoperation; HR 0.11 (0.013 to 0.96, p = 0.046). When inadequately fixed fractures were excluded, there was no difference in five-year survival for either reoperation (p = 0.156) or mechanical failure (p = 0.453). CONCLUSION Absolute reoperation rates are higher following LLP fixation of low PDFFs compared to DFA. Where LLP-ORIF was well performed with augmentation of medial comminution, there was no difference in survival compared to DFA. Though necessary in very low fractures, DFA should be used with caution in patients with greater life expectancies due to the risk of longer term aseptic loosening. Cite this article: Bone Joint J 2021;103-B(4):635-643.
Collapse
Affiliation(s)
- Lauren A Ross
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Oisin J F Keenan
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matthew Magill
- Department of Orthopaedics, Ninewells Hospital, Dundee, UK
| | | | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matt Moran
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - James T Patton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
5
|
Jennison T, Yarlagadda R. A case series of mortality and morbidity in distal femoral periprosthetic fractures. J Orthop 2019; 18:244-247. [PMID: 32071512 DOI: 10.1016/j.jor.2019.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022] Open
Abstract
Periprosthetic distal femoral fractures are occurring in increasing numbers. There is limited research into outcomes and mortality. This study aimed to assess the 1 year mortality and complications requiring further surgery in the two years following a presentation with a periprosthetic distal femoral fracture. A retrospective case series of periprosthetic distal femoral fractures at a single trauma centre was undertaken. All patients were included who presented with a distal femur periprosthetic fracture between 1st January and 2008 and 31st March 2015. 60 patients with 49 females and 11 males. Mean age was 80.7. Median time to surgery was 63 h 42 (70%) underwent open reduction internal fixation, 13 (21.7%) underwent revision arthroplasty and 5 (8.3%) underwent non-operative treatment. Median length of stay was 14 days. There were 12 (20%) complications requiring further surgery within 2 years. There were 2 (3.3%) deaths in 30 days and 8 (13.3%) within 1 year following fracture. Periprosthetic distal femoral fractures are becoming a common orthopaedic presentation. They occur in a complex group of patients and have high rates of mortality and complications.
Collapse
Affiliation(s)
- Toby Jennison
- Plymouth Hospitals NHS Trust, Derriford Road, Crownhill, Plymouth, Devon, PL6 8DH, UK
| | - Rathan Yarlagadda
- Plymouth Hospitals NHS Trust, Derriford Road, Crownhill, Plymouth, Devon, PL6 8DH, UK
| |
Collapse
|
6
|
Rhee SJ, Cho JY, Choi YY, Sawaguchi T, Suh JT. Femoral Periprosthetic Fractures after Total Knee Arthroplasty: New Surgically Oriented Classification with a Review of Current Treatments. Knee Surg Relat Res 2018; 30:284-292. [PMID: 29715713 PMCID: PMC6254877 DOI: 10.5792/ksrr.17.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/28/2017] [Accepted: 08/03/2017] [Indexed: 12/19/2022] Open
Abstract
Purpose As the number of total knee arthroplasties (TKAs) increases, the incidence of femoral periprosthetic fractures after TKA is also increasing. This review aimed to suggest a new surgically oriented classification system for femoral periprosthetic fractures. Methods We investigated the classifications, and current treatment trends for femoral periprosthetic fractures after TKA by means of a thorough review of the relevant literature. Results Numerous studies reported good results of surgical treatment with modern fixatives including locking compression plates and retrograde intramedullary nails. However, few classifications of femoral periprosthetic fractures reflect the recent developments in surgical treatment. Conclusions We recommend that surgical management be considered the first-line treatment for femoral periprosthetic fractures after TKA. Our new classification will help in deciding the surgical treatment option for femoral periprosthetic fractures after TKA.
Collapse
Affiliation(s)
- Seung Joon Rhee
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jae Young Cho
- Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan, Korea
| | - Yoon Young Choi
- Department of Diagnostic Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Takeshi Sawaguchi
- Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan
| | - Jeung Tak Suh
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
7
|
Validation of a new classification system for interprosthetic femoral fractures. Injury 2017; 48:1388-1392. [PMID: 28456366 DOI: 10.1016/j.injury.2017.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/31/2017] [Accepted: 04/11/2017] [Indexed: 02/02/2023]
Abstract
Interprosthetic femoral fracture (IFF) incidence is gradually increasing as the population is progressively ageing. However, treatment remains challenging due to several contributing factors, such as poor bone quality, patient comorbidities, small interprosthetic fragment, and prostheses instability. An effective and specific classification system is essential to optimize treatment management, therefore diminishing complication rates. This study aims to validate a previously described classification system for interprosthetic femoral fractures.
Collapse
|