title: The outcome and complications of the locked plating management for the periprosthetic distal femur fractures after a total knee arthroplasty.
abstract: BACKGROUND
  The osteosynthesis of the periprosthetic fractures following a total knee arthroplasty (TKA) can be technically difficult with the relatively small satisfactory outcomes and the high complication rates. The purpose of the study is to analyze the mid-term radiological and functional outcomes following the locked plating of the distal femur periprosthetic fractures after a TKA.
  
  
  METHODS
  Records of 20 patients with a periprosthetic distal femur fracture following TKA treated by the locked plate osteosynthesis were retrospectively evaluated. The union rate, complications and functional outcome measures were analyzed.
  
  
  RESULTS
  Successful union was achieved in 18 of the 19 patients available for the follow-up. The mean follow-up was 39 ± 10 months. Significant reductions (p < 0.05) in the range of motion and Western Ontario and McMaster Universities Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were evident in the follow-up. Secondary procedures were required in 5 patients to address the delay in union and the reduced knee range of motion. The osteosynthesis failed in 1 patient who underwent a revision TKA.
  
  
  CONCLUSIONS
  The satisfactory union rates can be achieved with the locked plate osteosynthesis in the periprosthetic distal femur fractures after TKA. Prolonged rehabilitation coupled with the un-modifiable risk factors can decrease the activity and satisfaction levels, which can significantly alter the functional outcome.
authors.affiliation: Department of Adult Joint Reconstructive Surgery, Parvathy Hospital, Chennai, India. gavaskar.ortho@gmail.com
authors.forename: Ashok S
authors.initials: AS
authors.lastname: Gavaskar
authors.forename: Naveen Chowdary
authors.initials: NC
authors.lastname: Tummala
authors.forename: Muthukumar
authors.initials: M
authors.lastname: Subramanian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000209:etiology*; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology; D057068:Periprosthetic Fractures / Q000000981:diagnostic imaging / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Distal femur fractures; Locked plating; Osteosynthesis; Periprosthetic fractures; Total knee arthroplasty