Locking compression plate versus retrograde intramedullary nail for periprosthetic supracondylar femoral fractures following total knee arthroplasty: a meta-analysis

Abstract

Objective To evaluate the efficacy of locking compression plate (LCP) and retrograde intramedullary nail (RIMN) in the treatment of periprosthetic fractures after total knee arthroplasty (TKA), providing reference for surgeons to select the fixation approach. Methods Cochrane Library, PubMed, Embase, Medline, Wanfang database, VIP Database for Chinese Technical Periodicals, and China National Knowledge Infrastructure (CNKI) were searched to identify the retrospective comparison studies (RCS) which compared the clinical outcomes of LCP and RIMN for patients with periprosthetic supracondylar fractures of the distal femur after TKA. The quality of included literatures was evaluated by Newcastle-Ottawa scale(NOS). Meta-analysis was performed using Revman 5.3 software to compare the operation time, Knee society score (KSS), fracture healing time, nonunion rate, reoperation rate, and incidence of complications between the two groups. Results Ten retrospective comparison studies involving 487 patients were identified including LCP group (296 cases) and RIMN group (191 cases). The meta analysis results showed that no significant differences were found in the operation time (MD=10.89, 95%CI -9.56-31.33, P>0.05), KSS (MD=1.11, 95%CI -8.88-11.10, P=0.83), fracture healing time (MD=0.00, 95%CI-1.51-1.51, P>0.05), nonunion rate (OR=0.71, 95%CI 0.38-1.31, P>0.05), reoperation rate (OR=0.65, 95%CI 0.22-1.91, P>0.05), and complication incidence rate (OR=0.69, 95%CI 0.38-1.26, P>0.05) between these two groups. Conclusions There are no significant differences in the operation time, KSS, fracture healing time, nonunion rate, reoperation rate, and complications between LCP and RIMN groups. LCP and RIMN have similar clinical outcomes in treating periprosthetic supracondylar femoral fracture following TKA. Key words: Femur; Periprosthetic fractures; Fracture fixation, internal; Meta-analysis