Distal femur periprosthetic knee fractures in elderly patients: clinical and radiographic outcome after internal fixation

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Gianluca Canton
Marko Tomic
Michele Giunta
Guido Maritan
Luigi Murena


periprosthetic knee fractures, distal femur, elderly, internal fixation, osteosynthesis, functional outcome


Background and aim of the work: The incidence of periprosthetic knee fractures is steadily increasing, especially in the geriatric population. Surgical treatment in these patients must consider the poor bone quality and the risks of general complications related to age and comorbidities. The aim of the present study is to analyze the clinical and radiographic outcome of internal fixation for periprosthetic knee fractures of the distal femur in elderly patients (>75aa).

Methods: All patients treated at the Orthopedic and Traumatology Unit of Cattinara Hospital-ASUGI (Trieste, Italy) between September 2014 and September 2019 for distal femur periprosthetic fracture after total knee replacement were included in the study. Mortality, complications, radiographic healing and functional outcomes were retrospectively evaluated. Data collection was conducted by clinical database searching and telephone interview. Results were compared with the literature.

Results: The study population included 19 patients, F:M 16:3, mean age 84 years. Plate fixation was used in the majority of cases (90%). One-year mortality was 21.05%. Radiographic healing of the fracture occurred in 92% of cases. Nonetheless, 61% of patients saw a worsening in their functional outcome.

Conclusion: Internal fixation is a valuable and safe option for distal femur periprosthetic fracture treatment in the elderly. The significant impact of periprosthetic knee fractures on the medium- to long-term survival and quality of life of the elderly patient is confirmed.


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1. Rahman WA, Vial TA, Backstein DJ. Distal Femoral Arthroplasty for Management of Periprosthetic Supracondylar Fractures of the Femur. J Arthroplasty. 2016;31(3):676-679.

2. Smith WR, Stoneback JW, Morgan SJ, Stahel PF. Is immediate weight bearing safe for periprosthetic distal femur fractures treated by locked plating? A feasibility study in 52 consecutive patients. Patient Saf Surg. 2016;10(1):1-5.

3. Ehlinger M, Adam P, Abane L, et al. Treatment of periprosthetic femoral fractures of the knee. Knee Surgery, Sport Traumatol Arthrosc. 2011;19(9):1473-1478.

4. Sun Y, Tang P, Zheng J, et al. Optimal Design of a Nonlinear Series Elastic Actuator for the Prosthetic Knee Joint Based on the Conjugate Cylindrical Cam. IEEE Access. 2019;7:140846-140859.

5. Herrera DA, Kregor PJ, Cole PA, Levy BA, Jönsson A, Zlowodzki M. Treatment of acute distal femur fractures above a total knee arthroplasty: Systematic review of 415 cases (1981-2006). Acta Orthop. 2008;79(1):22-27.

6. Benkovich V, Klassov Y, Mazilis B, Bloom S. Periprosthetic fractures of the knee: a comprehensive review. Eur J Orthop Surg Traumatol. 2020;30(3):387-399.

7. Rayan F, Konan S, Haddad FS. A review of periprosthetic fractures around total knee arthroplasties. Curr Orthop. 2008;22(1):52-61.

8. Rorabeck CH, Angliss RD, Lewis PL. Fractures of the femur, tibia, and patella after total knee arthroplasty: decision making and principles of management. Instr Course Lect. 1998;47:449–458.

9. Whitehouse MR, Mehendale S. Periprosthetic fractures around the knee: Current concepts and advances in management. Curr Rev Musculoskelet Med. 2014;7(2):136-144.

10. Platzer P, Schuster R, Aldrian S, et al. Management and outcome of periprosthetic fractures after total knee arthroplasty. J Trauma - Inj Infect Crit Care. 2010;68(6):1464-1470.

11. Su ET, DeWal H, Di Cesare PE. Periprosthetic femoral fractures above total knee replacements. J Am Acad Orthop Surg. 2004;12(1):12-20.

12. Hoffmann MF, Jones CB, Sietsema DL, Koenig SJ, Tornetta P. Outcome of periprosthetic distal femoral fractures following knee arthroplasty. Injury. 2012;43(7):1084-1089.

13. Head JM. Periprosthetic Distal Femur Fractures: Review of Current Treatment Options. Reconstr Rev. 2017;7(4).

14. Parrón R, Tomé F, Pajares S, et al. Treatment of Periprosthetic Knee Fractures in the Distal Femur by means of Retrograde Intramedullary Nailing. Rev Española Cirugía Ortopédica y Traumatol (English Ed. 2007;51(6):314-318.

15. Rao B, Kamal T, Vafe J, Moss M. Distal femoral replacement for selective periprosthetic fractures above a total knee arthroplasty. Eur J Trauma Emerg Surg. 2014;40(2):191-199.

16. Kim W, Song JH, Kim JJ. Periprosthetic fractures of the distal femur following total knee arthroplasty: even very distal fractures can be successfully treated using internal fixation. Int Orthop. 2015;39(10):1951-1957.

17. Konan S, Sandiford N, Unno F, Masri BS, Garbuz DS, Duncan CP. Periprosthetic fractures associated with total knee arthroplasty an update. Bone Jt J. 2016;98-B(11):1489-1496.

18. Nauth A, Ristevski B, Bégué T, Schemitsch EH. Periprosthetic distal femur fractures: Current concepts. J Orthop Trauma. 2011;25(SUPPL. 1):82-85.

19. Ricci WM. Periprosthetic femur fractures. J Orthop Trauma. 2015;29(3):130-137.

20. Gan G, Teo YH, Kwek EBK. Comparing outcomes of tumor prosthesis revision and locking plate fixation in supracondylar femoral periprosthetic fractures. CiOS Clin Orthop Surg. 2018;10(2):174-180.

21. Verma N, Jain A, Pal C, Thomas S, Agarwal S, Garg P. Management of periprosthetic fracture following total knee arthroplasty- a retrospective study to decide when to fix or when to revise? J Clin Orthop Trauma. 2020;11:S246-S254.

22. Ebraheim NA, Liu J, Hashmi SZ, Sochacki KR, Moral MZ, Hirschfeld AG. High Complication Rate in Locking Plate Fixation of Lower Periprosthetic Distal Femur Fractures in Patients With Total Knee Arthroplasties. J Arthroplasty. 2012;27(5):809-813.

23. Singh JA, Jensen M, Lewallen D. Predictors of periprosthetic fracture after total knee replacement: An analysis of 21,723 cases. Acta Orthop. 2013;84(2):170-177.

24. Meek RMD, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Jt Surg - Ser B. 2011;93 B(1):96-101.

25. Sarmah SS, Patel S, Reading G, El-Husseiny M, Douglas S, Haddad FS. Periprosthetic fractures around total knee arthroplasty. Ann R Coll Surg Engl. 2012;94(5):302-307.

26. Anakwe RE, Aitken SA, Khan LAK. Osteoporotic periprosthetic fractures of the femur in elderly patients: Outcome after fixation with the LISS plate. Injury. 2008;39(10):1191-1197.

27. Chalmers BP, Limberg AK, Athey AG, Perry KI, Pagnano MW, Abdel MP. Total knee arthroplasty after distal femoral osteotomy. Bone Jt J. 2019;101 B(6):660-666.

28. Gondalia V, Choi DH, Lee SC, et al. Periprosthetic supracondylar femoral fractures following total knee arthroplasty: clinical comparison and related complications of the femur plate system and retrograde-inserted supracondylar nail. J Orthop Traumatol. 2014;15(3):201-207.

29. Goldberg VM, Figgie MP. The results of treatment of supracondylar fracture above total knee arthroplasty. J Arthroplasty. 1990;5(3):267-276.

30. Tandon T, Tadros BJ, Avasthi A, Hill R, Rao M. Management of periprosthetic distal femur fractures using distal femoral arthroplasty and fixation - Comparative study of outcomes and costs. J Clin Orthop Trauma. 2020;11(1):160-164.

31. Melani T, Sani G, Carulli C, Innocenti M. Attualità sulle fratture periprotesiche di ginocchioPeriprosthetic fractures of the knee: an update. LO SCALPELLO-OTODI Educ. 2018;32(1):56-59.

32. Gracia-Ochoa M, Miranda I, Orenga S, Hurtado-Oliver V, Sendra F, Roselló-Añón A. Fracturas periprotésicas de fémur sobre prótesis de cadera y rodilla. Análisis de una serie de 34 casos y revisión de las series españolas en los últimos 20 años. Rev Esp Cir Ortop Traumatol. 2016;60(5):271-278.

33. Lotzien S, Hoberg C, Hoffmann MF, Schildhauer TA. Clinical outcome and quality of life of patients with periprosthetic distal femur fractures and retained total knee arthroplasty treated with polyaxial locking plates: a single-center experience. Eur J Orthop Surg Traumatol. 2019;29(1):189-196.

34. Gavaskar AS, Tummala NC, Subramanian M. The outcome and complications of the locked plating management for the periprosthetic distal femur fractures after a total knee arthroplasty. Clin Orthop Surg. 2013;5(2):124-128.

35. Hou Z, Bowen TR, Irgit K, et al. Locked plating of periprosthetic femur fractures above total knee arthroplasty. J Orthop Trauma. 2012;26(7):427-432.

36. Mortazavi SMJ, Kurd MF, Bender B, Post Z, Parvizi J, Purtill JJ. Distal Femoral Arthroplasty for the Treatment of Periprosthetic Fractures After Total Knee Arthroplasty. J Arthroplasty. 2010;25(5):775-780.

37. Bezwada HP, Neubauer P, Baker J, Israelite CL, Johanson NA. Periprosthetic supracondylar femur fractures following total knee arthroplasty. J Arthroplasty. 2004;19(4):453-458.

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