The Result of Treatment of Femoral Periprosthetic Fractures after Total Knee Arthroplasty

Jun-Beom Kim; In-Soo Song; Dong-Hyuk Sun; Hyun Choi

doi:10.4055/jkoa.2014.49.6.446

Journal List > J Korean Orthop Assoc > v.49(6) > 1013336

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Kim, Song, Sun, and Choi: The Result of Treatment of Femoral Periprosthetic Fractures after Total Knee Arthroplasty

Original Article

Journal of the Korean Orthopaedic Association 2014; 49(6): 446-453.

Published online: 30 December 2014

DOI: https://doi.org/10.4055/jkoa.2014.49.6.446

The Result of Treatment of Femoral Periprosthetic Fractures after Total Knee Arthroplasty

Jun-Beom Kim, M.D., In-Soo Song, M.D., Dong-Hyuk Sun, M.D., Hyun Choi, M.D.

Department of Orthopaedic Surgery, Daejeon Sun Hospital, Daejeon, Korea.

Correspondence to: In-Soo Song, M.D. Department of Orthopaedic Surgery, Daejeon Sun Hospital, 29 Mokjung-ro, Jung-gu, Daejeon 301-725, Korea. TEL: +82-42-220-8220, FAX: +82-42-221-0429, mydangjang@naver.com

Received 28 May 2014 Revised 9 August 2014 Accepted 26 August 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We assessed and compared the clinical and radiologic outcomes of treatment in periprosthetic fractures of the femur after total knee arthroplasty.

Materials and Methods

We compared 22 knees, 22 patients of femoral periprosthetic fractures which had been fixed with absolute stabilization such as plate or screw fixation in 16 cases (group A), and with relative stabilization such as retrograde intramedullary nailing or Ender nailing in six cases (group B) from November 2004 to March 2013; the mean follow-up period was 51.9 months.

Results

The mean tibio femoral angle and the mean mechanical axis showed statistically significant change in group B, between before fracture and last follow-up. The mean bone union time and the mean hospital for special surgery score were not significantly different between group A and B. Nonunion was demonstrated in one case in each group, malunion was demonstrated in one case in group B.

Conclusion

In the treatment of periprosthetic fractures of the femur after total knee arthroplasty, absolute stabilization had an advantage for regain of limb alignment. Among the complications, more cases of refracture and infection were observed in the absolute stabilization group, while more cases of nonunion and malunion were observed in the relative stabilization group.

Keywords: total knee replacement, internal fixators

Figures and Tables

Figure 1

(A) These preoperative radiographs of a 76-year-old female patient show a Rorabeck type II periprosthetic femoral fracture. (B) Postoperative radiographs show a well reduced fracture line using a dual locking compression plate. (C) Twelve-months follow-up radiographs demonstrate a well healed fracture and good alignment.

Figure 2

(A) These preoperative radiographs of a 78-year-old female patient shows a Rorabeck type II periprosthetic femoral fracture due to anterior notching. (B) Postoperative radiographs show good reduction of the fracture site using a retrograde intramedullary nail. (C) Fifteen-months follow-up radiographs demonstrate successful bone union with metal removal, but remaining anterior notching and malalignment.

Table 1

Demographics of 22 Patients with Periprosthetic Fracture Following TKA

TKA, total knee arthroplasty.

Table 2

Comparison of Treatment Results of Group A (Absolute Stabilization) and Group B (Relative Stabilization)

MAA, mechanical axis angle; T-F angle, tibiofemoral angle; HSS, hospital for special surgery; ROM, range of motion.

Table 3

Postoperative Complications

Im, intramedullary.

Notes

This article was announced at 2014 The Korean Orthopedic Association Annual Fall Congress.

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