Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 9, pp 2921–2928 | Cite as

Similar outcomes of locking compression plating and retrograde intramedullary nailing for periprosthetic supracondylar femoral fractures following total knee arthroplasty: a meta-analysis

  • Young-Soo Shin
  • Hyun-Jung Kim
  • Dae-Hee LeeEmail author



This meta-analysis was designed to compare clinical outcomes, including knee scale score and nonunion rate, of patients with periprosthetic supracondylar fractures of the distal femur after total knee arthroplasty (TKA) who were treated using locking compression plates and retrograde intramedullary nails.


Studies were included in this meta-analysis if they compared clinical outcomes, including operation time, Knee Society Score (KSS), time to union, nonunion rate, and revision rate due to nonunion, in patients who underwent locking compression plate or retrograde intramedullary nail for periprosthetic distal femur fractures following TKA.


Eight studies were included in this meta-analysis. Mean operation time was 11 min shorter (95 % CI −9.56 to 31.33 min; n.s.) and KSS one point higher (95 % CI −8.88 to 11.10; n.s.) with retrograde intramedullary nail than with locking compression plate, but these differences were not statistically significant. The two groups were also similar in mean time to union (0.46 weeks 95 % CI −1.17 to 2.08 weeks; n.s.), the proportion of subjects with nonunion (OR 0.83, 95 % CI 0.26–2.60; n.s.) and the proportion that underwent revision surgery (OR 0.88, 95 % CI 0.32–2.40; n.s.).


Clinical outcomes, including nonunion and revision rates, were similar in patients who underwent locking compression plate and retrograde intramedullary nail fixation for periprosthetic supracondylar femoral fracture following TKA. Orthopaedic surgeons must train to master both the retrograde intramedullary nail and locking compression plate techniques because both approaches can be considered for periprosthetic distal femur fracture after TKA as they have similar clinicoradiologic outcomes.

Level of evidence



Total knee arthroplasty Periprosthetic fracture Distal femur Locking plate Intramedullary nail 


  1. 1.
    Aldrian S, Schuster R, Haas N, Erhart J, Strickner M, Blutsch B, Wernhart S, Leitgeb J, Platzer P (2013) Fixation of supracondylar femoral fractures following total knee arthroplasty: is there any difference comparing angular stable plate fixation versus rigid interlocking nail fixation? Arch Orthop Trauma Surg 133:921–927CrossRefPubMedGoogle Scholar
  2. 2.
    Bae DK, Song SJ, Yoon KH, Kim TY (2014) Periprosthetic supracondylar femoral fractures above total knee arthroplasty: comparison of the locking and non-locking plating methods. Knee Surg Sports Traumatol Arthrosc 22:2690–2697CrossRefPubMedGoogle Scholar
  3. 3.
    Bezwada HP, Neubauer P, Baker J, Israelite CL, Johanson NA (2004) Periprosthetic supracondylar femur fractures following total knee arthroplasty. J Arthroplasty 19:453–458CrossRefPubMedGoogle Scholar
  4. 4.
    Bong MR, Egol KA, Koval KJ, Kummer FJ, Su ET, Iesaka K, Bayer J, Di Cesare PE (2002) Comparison of the LISS and a retrograde-inserted supracondylar intramedullary nail for fixation of a periprosthetic distal femur fracture proximal to a total knee arthroplasty. J Arthroplasty 17:876–881CrossRefPubMedGoogle Scholar
  5. 5.
    Chettiar K, Jackson MP, Brewin J, Dass D, Butler-Manuel PA (2009) Supracondylar periprosthetic femoral fractures following total knee arthroplasty: treatment with a retrograde intramedullary nail. Int Orthop 33:981–985CrossRefPubMedGoogle Scholar
  6. 6.
    Ehlinger M, Adam P, Abane L, Rahme M, Moor BK, Arlettaz Y, Bonnomet F (2011) Treatment of periprosthetic femoral fractures of the knee. Knee Surg Sports Traumatol Arthrosc 19:1473–1478CrossRefPubMedGoogle Scholar
  7. 7.
    Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H (1999) Minimally invasive plate osteosynthesis: does percutaneous plating disrupt femoral blood supply less than the traditional technique? J Orthop Trauma 13:401–406CrossRefPubMedGoogle Scholar
  8. 8.
    Gavaskar AS, Tummala NC, Subramanian M (2013) The outcome and complications of the locked plating management for the periprosthetic distal femur fractures after a total knee arthroplasty. Clin Orthop Surg 5:124–128CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Gondalia V, Choi DH, Lee SC, Nam CH, Hwang BH, Ahn HS, Ong AC, Park HY, Jung KA (2014) 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 15:201–207CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ha CW, Shon OJ, Lim SW, Park KH (2014) Minimally invasive plate osteosynthesis for periprosthetic distal femoral fractures after total knee arthroplasty. Knee Surg Relat Res 26:27–32CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Herrera DA, Kregor PJ, Cole PA, Levy BA, Jonsson A, Zlowodzki M (2008) Treatment of acute distal femur fractures above a total knee arthroplasty: systematic review of 415 cases (1981–2006). Acta Orthop 79:22–27CrossRefPubMedGoogle Scholar
  12. 12.
    Horneff JG 3rd, Scolaro JA, Jafari SM, Mirza A, Parvizi J, Mehta S (2013) Intramedullary nailing versus locked plate for treating supracondylar periprosthetic femur fractures. Orthopedics 36:e561–e566CrossRefPubMedGoogle Scholar
  13. 13.
    Hou Z, Bowen TR, Irgit K, Strohecker K, Matzko ME, Widmaier J, Smith WR (2012) Locked plating of periprosthetic femur fractures above total knee arthroplasty. J Orthop Trauma 26:427–432CrossRefPubMedGoogle Scholar
  14. 14.
    Johnston AT, Tsiridis E, Eyres KS, Toms AD (2012) Periprosthetic fractures in the distal femur following total knee replacement: a review and guide to management. Knee 19:156–162CrossRefPubMedGoogle Scholar
  15. 15.
    Kilucoglu OI, Akgül T, Sağlam Y, Yazıcıoğlu O (2013) Comparison of locked plating and intramedullary nailing for periprosthetic supracondylar femur fractures after knee arthroplasty. Acta Orthop Belg 79:417–421PubMedGoogle Scholar
  16. 16.
    Large TM, Kellam JF, Bosse MJ, Sims SH, Althausen P, Masonis JL (2008) Locked plating of supracondylar periprosthetic femur fractures. J Arthroplasty 23:115–120CrossRefPubMedGoogle Scholar
  17. 17.
    Lee SS, Lim SJ, Moon YW, Seo JG (2014) Outcomes of long retrograde intramedullary nailing for periprosthetic supracondylar femoral fractures following total knee arthroplasty. Arch Orthop Trauma Surg 134:47–52CrossRefPubMedGoogle Scholar
  18. 18.
    Lehmann W, Rupprecht M, Nuechtern J, Melzner D, Sellenschloh K, Kolb J, Fensky F, Hoffmann M, Puschel K, Morlock M, Rueger JM (2012) What is the risk of stress risers for interprosthetic fractures of the femur? A biomechanical analysis. Int Orthop 36:2441–2446CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Li B, Gao P, Qiu G, Li T (2015) Locked plate versus retrograde intramedullary nail for periprosthetic femur fractures above total knee arthroplasty: a meta-analysis. Int Orthop [Epub ahead of print] Google Scholar
  20. 20.
    Makinen TJ, Dhotar HS, Fichman SG, Gunton MJ, Woodside M, Safir O, Backstein D, Willett TL, Kuzyk PR (2015) Periprosthetic supracondylar femoral fractures following knee arthroplasty: a biomechanical comparison of four methods of fixation. Int Orthop 39:1737–1742CrossRefPubMedGoogle Scholar
  21. 21.
    Meneghini RM, Keyes BJ, Reddy KK, Maar DC (2014) Modern retrograde intramedullary nails versus periarticular locked plates for supracondylar femur fractures after total knee arthroplasty. J Arthroplasty 29:1478–1481CrossRefPubMedGoogle Scholar
  22. 22.
    Pekmezci M, McDonald E, Buckley J, Kandemir U (2014) Retrograde intramedullary nails with distal screws locked to the nail have higher fatigue strength than locking plates in the treatment of supracondylar femoral fractures: a cadaver-based laboratory investigation. Bone Joint J 96-B:114–121CrossRefPubMedGoogle Scholar
  23. 23.
    Pelfort X, Torres-Claramunt R, Hinarejos P, Leal J, Gil-Gonzalez S, Puig L (2013) Extension malunion of the femoral component after retrograde nailing: no sequelae at 6 years. J Orthop Trauma 27:158–161CrossRefPubMedGoogle Scholar
  24. 24.
    Ricci WM (2015) Periprosthetic femur fractures. J Orthop Trauma 29:130–137CrossRefPubMedGoogle Scholar
  25. 25.
    Ristevski B, Nauth A, Williams DS, Hall JA, Whelan DB, Bhandari M, Schemitsch EH (2014) Systematic review of the treatment of periprosthetic distal femur fractures. J Orthop Trauma 28:307–312CrossRefPubMedGoogle Scholar
  26. 26.
    Thukral R, Marya S, Singh C (2015) Management of distal femoral periprosthetic fractures by distal femoral locking plate: a retrospective study. Indian J Orthop 49:199–207CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Wick M, Müller EJ, Kutscha-Lissberg F, Hopf F, Muhr G (2004) Periprosthetic supracondylar femoral fractures: LISS or retrograde intramedullary nailing? Problems with the use of minimally invasive technique. Unfallchirurg 107:181–188CrossRefPubMedGoogle Scholar
  28. 28.
    Yoo JD, Kim NK (2015) Periprosthetic fractures following total knee arthroplasty. Knee Surg Relat Res 27:1–9CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  1. 1.Department of Orthopedic SurgerySeoul Veterans HospitalSeoulKorea
  2. 2.Department of Preventive MedicineKorea University College of MedicineSeoulKorea
  3. 3.Department of Orthopaedic Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea

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