Abstract
PurposeThis study reviewed the literature regarding the patient-reported treatment outcomes of using either open reduction and internal fixation (ORIF) with a plate and screw system or intramedullary nail (IMN) fixation for periprosthetic distal femur fractures around a total knee arthroplasty.MethodsA total of 13 studies published in the last 20 years met the inclusion criteria. The studies included 347 patients who were allocated to ORIF (n = 249) and IMN (n = 98) groups according to the implants used. The primary outcome measures were the Knee Society Score or the Western Ontario and McMaster Universities osteoarthritis index. The secondary outcome measures included knee range of motion and the rates of complications, including non-union, malunion, infection, revision total knee arthroplasty, and reoperation. Statistical significance was set at P < 0.05.ResultsThe mean Knee Society Scores of ORIF and IMN groups were 83 and 84, respectively; the mean postoperative range of motion of the knee were 99° and 100°, respectively (P < 0.05); the non-union rates were 9.4 and 3.8%, respectively (P > 0.05); the malunion rates were 1.8 and 7.5%, respectively (P < 0.05); surgical site infection rates were 2 and 1.3%, respectively (P > 0.05); the reoperation rates were 9.6 and 5.1%, respectively (P > 0.05); and revision rates of total knee arthroplasty were 2 and 1%, respectively (P > 0.05).ConclusionBased on the patient-reported outcome assessments, both ORIF with a plate and screw system and IMN fixation are well-accepted techniques for periprosthetic distal femur fractures around a TKA, and they produce similar functional outcomes.
Highlights
The incidences of periprosthetic fractures (PPFs) are on the rise around the globe
The incidence is expected to increase as more total knee arthroplasty (TKA) are being performed annually, and the patients continue to live longer with their TKAs [5]
The open reduction and internal fixation (ORIF) group consisted of 11 studies (249 patients) [19,20,21, 23,24,25,26, 28,29,30,31]
Summary
The incidences of periprosthetic fractures (PPFs) are on the rise around the globe. The reported incidence of PPFs around a total knee arthroplasty (TKA) stand at somewhere between 0.3 and 2.5% [1,2,3]. The risk factors include advanced age, diabetes, elevated body mass index, female gender, and anterior femoral notching during the index procedure [4]. The incidence is expected to increase as more TKAs are being performed annually, and the patients continue to live longer with their TKAs [5]. In addition to the cost associated with the management of PPFs, increased morbidity and mortality pose challenges [6]. The management of PPFs around a TKA demands significant resource input and incurs high healthcare costs [7]. Most PPFs require surgical intervention (2021) 3:24
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