title: Midterm results of treatment with a retrograde nail for supracondylar periprosthetic fractures of the femur following total knee arthroplasty.
abstract: OBJECTIVE
  Although the short-term results of supracondylar periprosthetic fractures treated with retrograde nailing have been satisfactory, there is always a concern about the long-term survival of the prosthesis. The aim of the study was to evaluate fracture healing and knee functional outcome with a follow-up time of at least 2 years in periprosthetic fractures of the knee treated with a supracondylar nail.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  There were 9 patients with 10 periprosthetic fractures. In 1 patient, the fracture occurred intraoperatively. In the others, the time between the total knee arthroplasty and the periprosthetic fracture ranged between 2 weeks and 7 years (average time: 2.78 years). The mean follow-up was 34.5 months (25-52 months).
  
  
  METHODS
  The Western Ontario and McMaster Universities index was used to evaluate the functional result postoperatively using the paired t test as the statistical test. Fracture union was assessed with plain x-rays.
  
  
  RESULTS
  All the fractures united within 3 months. One fracture united in extreme valgus (35 degrees) and was revised to a stemmed total knee replacement. There were no infections and no prosthesis loosening. The paired t test before the fracture and after the operation demonstrated no statistically significant differences; however, there was a trend toward lower functional score postoperatively.
  
  
  CONCLUSIONS
  It appears that retrograde nailing is a reliable technique to treat periprosthetic supracondylar fractures. It provides adequate stability until fracture union. The morbidity of the operation is minimal, and the complication rate is low. The midterm results in our study showed that none of the prostheses required revision. In our opinion, it is the treatment of choice for a periprosthetic fracture when the prosthesis is stable.
authors.affiliation: Orthopaedic Department, University Hospital of Patras, Rio, Greece. gliatis@hotmail.com
authors.forename: John
authors.initials: J
authors.lastname: Gliatis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Megas
authors.forename: Elias
authors.initials: E
authors.lastname: Panagiotopoulos
authors.forename: Elias
authors.initials: E
authors.lastname: Lambiris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D011795:Surveys and Questionnaires