Treatment of acute distal femur fractures above a total knee arthroplasty: Systematic review of 415 cases (1981-2006)

Diego A. Herrera, Philip J. Kregor, Peter A. Cole, Bruce A. Levy, Anders Jönsson, Michael Zlowodzki

Research output: Contribution to journalArticle

128 Citations (Scopus)

Abstract

Background: There is no consensus on the best treatment for periprosthetic supracondylar fracture. Material and methods: We systematically summarized and compared results of different fixation techniques in the management of acute distal femur fractures above a total knee arthroplasty (TKA). Several databases were searched (Medline, Cochrane library, OTA and AAOS abstract databases) and baseline and outcome parameters were abstracted. Results: We extracted data from 29 case series with a total of 415 fractures. The following outcomes were noted: a nonunion rate of 9%, a fixation failure rate of 4%, an infection rate of 3%, and a revision surgery rate of 13%. Retrograde nailing was associated with relative risk reduction (RRR) of 87% (p = 0.01) for developing a nonunion and 70% (p = 0.03) for requiring revision surgery compared to traditional (non-locking) plating methods. Point estimates also suggested risk reductions for locking plates, although these were not statistically significant (57% for nonunion, p = 0.2; 43% for revision surgery, p = 0.23) compared to traditional plating. RRRs for nonunion and revision surgery were also statistically significantly lower for retrograde nailing and locking plates compared to nonoperative treatment. Interpretation: Modern-day treatment methods are superior to conventional treatment options in the management of distal femur fractures above TKAs. The results should be interpreted with caution, due to the lack of randomized controlled trials and the possible selection bias in case series. Copyright

Original languageEnglish (US)
Pages (from-to)22-27
Number of pages6
JournalActa Orthopaedica
Volume79
Issue number1
DOIs
StatePublished - Feb 1 2008
Externally publishedYes

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Knee Replacement Arthroplasties
Reoperation
Femur
Risk Reduction Behavior
Periprosthetic Fractures
Databases
Selection Bias
Therapeutics
Libraries
Consensus
Randomized Controlled Trials
Infection

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Treatment of acute distal femur fractures above a total knee arthroplasty : Systematic review of 415 cases (1981-2006). / Herrera, Diego A.; Kregor, Philip J.; Cole, Peter A.; Levy, Bruce A.; Jönsson, Anders; Zlowodzki, Michael.

In: Acta Orthopaedica, Vol. 79, No. 1, 01.02.2008, p. 22-27.

Research output: Contribution to journalArticle

Herrera, Diego A. ; Kregor, Philip J. ; Cole, Peter A. ; Levy, Bruce A. ; Jönsson, Anders ; Zlowodzki, Michael. / Treatment of acute distal femur fractures above a total knee arthroplasty : Systematic review of 415 cases (1981-2006). In: Acta Orthopaedica. 2008 ; Vol. 79, No. 1. pp. 22-27.
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