title: Primary versus secondary distal femoral arthroplasty for treatment of total knee arthroplasty periprosthetic femur fractures.
abstract: Current methods of fixing periprosthetic fractures after total knee arthroplasty (TKA) are variable, and include open reduction and internal fixation (ORIF) via plating, retrograde nailing, or revision using standard revision TKA components or a distal femoral arthroplasty (DFA). The purpose of this study is to compare patients who failed plating techniques requiring subsequent revision to DFA to patients who underwent primary DFA. Of the 13 patients (9.2%) who failed primary ORIF, causes included nonunion (53.8%), infection (30.8%), loosening (7.7%), and refracture (7.7%). There were significantly more surgical procedures for ORIF revision to DFA compared to primary DFA. Complications for patients who underwent primary reconstruction with DFAs included extensor mechanism disruption (8.3%), infection (5.6%), and dislocation (2.8%). Primary reconstruction via ORIF is beneficial for preserving bone stock, but primary DFA may be preferred in osteopenic patients, or those at high risk for nonunion.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Antonia F
authors.initials: AF
authors.lastname: Chen
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Choi
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Colman
authors.forename: Mark A
authors.initials: MA
authors.lastname: Goodman
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Crossett
authors.forename: Ivan S
authors.initials: IS
authors.lastname: Tarkin
authors.forename: Richard L
authors.initials: RL
authors.lastname: McGough
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001860:Bone Plates; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000601:surgery*; D005269:Femur / Q000293:injuries / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies
keywords: distal femoral arthroplasty; failure; femur fractures; open reduction and internal fixation; periprosthetic fractures; total knee arthroplasty