title: The effect of femoral notching during total knee arthroplasty on the prevalence of postoperative femoral fractures and on clinical outcome.
abstract: BACKGROUND
  The treatment of a supracondylar femoral fracture following total knee arthroplasty is complicated by the presence of the prosthetic components. Anterior femoral notching during arthroplasty has been implicated as a contributing risk factor for femoral fracture. We retrospectively reviewed the effect of anterior femoral notching on the subsequent occurrence of a periprosthetic supracondylar fracture of the distal aspect of the femur and the outcomes of primary total knee arthroplasty in such patients.
  
  
  METHODS
  The prevalence and depth of femoral notching were determined on a review of the lateral radiographs by observers blinded to the clinical results of 1089 consecutive total knee replacements performed in 1997 and 1998. Linear and logistic regression modeling was used to analyze the relationship between femoral notching and the prevalence of supracondylar femoral fracture, postoperative range of motion, the Knee Society score, and the Knee Society functional and pain scores.
  
  
  RESULTS
  Femoral notching was performed in 325 (29.8%) of the 1089 knees in our series. During an average follow-up period of 5.1 years, only two supracondylar femoral fractures occurred, both in femora treated without notching. Femoral notching was not associated with an increased rate of fracture (p = 1.000) or with significant differences in the measures of outcome (range of motion [p = 0.117], knee score [p = 0.967], functional score [p = 0.861], need for a lateral release [p = 0.234], or postoperative pain [p = 0.948]).
  
  
  CONCLUSIONS
  This study demonstrated no difference in knees managed with or without notching of the anterior distal aspect of the femur with respect to the occurrence of a supracondylar fracture, range of motion, Knee Society score, Knee Society function, or pain.
authors.affiliation: The Center for Hip and Knee Surgery, St. Francis Hospital, 1199 Hadley Road, Mooresville, IN 46158, USA. marittermd@yahoo.com
authors.forename: Merrill A
authors.initials: MA
authors.lastname: Ritter
authors.forename: Alan E
authors.initials: AE
authors.lastname: Thong
authors.forename: E Michael
authors.initials: EM
authors.lastname: Keating
authors.forename: Philip M
authors.initials: PM
authors.lastname: Faris
authors.forename: John B
authors.initials: JB
authors.lastname: Meding
authors.forename: Michael E
authors.initials: ME
authors.lastname: Berend
authors.forename: Jeffery L
authors.initials: JL
authors.lastname: Pierson
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Davis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology / Q000209:etiology*; D005269:Femur / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome