title: Distal femoral fracture during primary total knee arthroplasty.
abstract: OBJECTIVE
  To review 6 cases of periprosthetic distal femoral fracture during total knee arthroplasty (TKA).
  
  
  METHODS
  Of 778 women and 691 men who underwent primary TKAs using posterior-stabilised (n=1240), cruciate-retaining (n=165), or semiconstrained (n=64) implant, 5 women and one man with a mean age of 73.3 years and a mean body mass index of 31.6 kg/m(2) sustained an intra-operative periprosthetic distal femoral fracture and were followed up for a mean of 12.8 (range, 2-39) months.
  
  
  RESULTS
  Respectively in patients with a posterior-stabilised, cruciate-retaining, or semi-constrained implant, the intra-operative fracture rates were 0.32%, 0%, and 3.13%. For women, the respective rates were 0.46%, 0%, and 5.10%. Intra-operative fracture was 9.69 times (p=0.03) more likely to occur in patients with a semi-constrained implant than those with a posterior-stabilised implant, and was 4.44 times (p=0.22) more likely to occur in women than in men. Half of the fractures occurred during the trial phase when the tibia was reduced onto the femur, and half during final prosthesis implantation.
  
  
  CONCLUSIONS
  Distal femoral fracture during primary TKA is rare and associated with the use of a semiconstrained implant. Preserving as much bone in the distal femur is advised.
authors: Department of Radiology, Mount Sinai Medical Center, Miami Beach, FL, USA.
authors: Lawrence A
authors: LA
authors: Delasotta
authors: Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors: Fabio
authors: F
authors: Orozco
authors: Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors: Adam G
authors: AG
authors: Miller
authors: Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors: Zachary
authors: Z
authors: Post
authors: Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors: Alvin
authors: A
authors: Ong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D057068:Periprosthetic Fractures / Q000209:etiology* / Q000601:surgery
keywords: arthroplasty, replacement, knee; intraoperative complications