Abstract
PurposeThis study aimed to determine whether unrestricted weight-bearing as tolerated (WBAT) following lateral locking plate (LLP) fixation of periprosthetic distal femoral fractures (PDFFs) is associated with increased failure and reoperation, compared with restricted weight-bearing (RWB).Materials and methodsIn a retrospective cohort study of consecutive patients with unilateral PDFFs undergoing LLP fixation, patients prescribed WBAT were compared with those prescribed 6 weeks of RWB. The primary outcome measure was reoperation. Kaplan–Meier and Cox multivariable analyses were performed.ResultsThere were 43 patients (mean age 80.9 ± 11.7 years, body mass index 26.8 ± 5.7 kg/m2 and 86.0% female): 28 WBAT and 15 RWB. There were more interprosthetic fractures in the RWB group (p = 0.040). Mean follow-up was 3.8 years (range 1.0–10.4). Eight patients (18.6%) underwent reoperation. Kaplan–Meier analysis demonstrated no difference in 2-year survival between WBAT (80.6%, 95% CI 65.3–95.9) and RWB (83.3%, 95% CI 62.1–100.0; p = 0.54). Cox analysis showed increased reoperation risk with medial comminution (hazard ratio 10.7, 95% CI 1.5–80; p = 0.020) and decreased risk with anatomic reduction (hazard ratio 0.11, 95% CI 0.01–1.0; p = 0.046). Immediate weight-bearing did not significantly affect the risk of reoperation compared with RWB (relative risk 1.03, 95% CI 0.61–1.74; p = 0.91).ConclusionsLLP fixation failure was associated with medial comminution and non-anatomic reductions, not with postoperative weight-bearing. Medial comminution should be managed with additional fixation. Weight-bearing restrictions additional to this appear unnecessary and should be avoided.
Highlights
The number of primary total knee arthroplasties (TKAs) performed is increasing annually [1]
Proximal diaphyseal-type fractures can be treated with retrograde femoral nailing [8], where fixation is undertaken for more distal fractures a lateral locking plate (LLP) is typically used, with or without additional augmentation [9, 10]
Consecutive patients with periprosthetic distal femoral fractures (PDFFs) involving well-fixed TKAs treated at the study institution between January 2011 and December 2019 were identified from admission lists and operating lists
Summary
The number of primary total knee arthroplasties (TKAs) performed is increasing annually [1]. In the context of an aging population [2], periprosthetic distal femoral fractures (PDFFs) represent an increasing burden on patients and surgeons [3,4,5], with a current incidence estimated at 2.4 per 100,000 population per year [6]. These fractures are typically fragility fractures affecting older and often frail patients [7]. Where fractures are proximal to well-fixed femoral components with adequate bone stock, they are usually managed with fixation, as opposed to revision arthroplasty [4].
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