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Clinical outcome and quality of life of patients with periprosthetic distal femur fractures and retained total knee arthroplasty treated with polyaxial locking plates: a single-center experience

  • Sebastian LotzienEmail author
  • Clemens Hoberg
  • Martin F. Hoffmann
  • Thomas A. Schildhauer
Original Article • LOWER LIMB - FRACTURES
  • 196 Downloads

Abstract

Purpose

The number of total knee arthroplasties (TKA) increased rapidly. In conjunction with higher implantation rates, periprosthetic femur fractures following TKA are also gradually increasing. Purpose of this study was to evaluate polyaxial locking plate treatment of periprosthetic femoral fractures with retained total knee replacement using polyaxial locking plates in regard to quality of life, functional outcome and complications.

Methods

The Study design is a single-center retrospective cohort analysis. Included were patients with periprosthetic supracondylar femoral fractures with a well-fixed knee prosthesis initially treated with NCB plate (Non-contact bridging plate, Zimmer Inc., Warsaw, IN). Primary outcome was measured including quality of life and functional status using the SMFA-D score (German short musculoskeletal function assessment questionnaire), the mortality rate and union rate. Formerly published SMFA—data presenting representative randomly chosen cross-sectional data from general population of the USA and Dutch population was used as historic control group.

Results

In total, 45 patients with a mean age of 74 years were included (10 males; 35 females). Body mass index averaged 27.4 kg/m2. Follow-up averaged 52 months. Comparison of the SMFA-D scores showed higher scores according to bother index (41.5 vs. 15.7/13.8) and function index (42.5 vs. 14.5/12.7). Mortality rate was 26.7%. The CCI was directly related to the mortality rate (p = 0.033). Union was achieved in 35 of 45 fractures (78%) six months after the index procedure. The ultimate union rate including following procedures at last follow-up was 95.6%.

Conclusion

Besides already highlighted limitations in range of motion, we quantified patient-related limitations in daily living. A large number of patients after surgery are not self-reliant mobile or on orthopedic aids. A high CCI was directly related to the mortality rate and can be used as a predictive factor for postoperative mortality.

Keywords

Periprosthetic Total knee replacement Fracture Locking plate Outcome 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Human and animal rights

This study was a retrospective non-interventional analysis of surgical treatment of human participants.

References

  1. 1.
    Aldrian S, Schuster R, Haas N et al (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 133:921–927CrossRefGoogle Scholar
  2. 2.
    Barei DP, Agel J, Swiontkowski MF (2007) Current utilization, interpretation, and recommendations: the musculoskeletal function assessments (MFA/SMFA). J Orthop Trauma 21:738–742CrossRefGoogle Scholar
  3. 3.
    Bhattacharyya T, Chang D, Meigs JB et al (2007) Mortality after periprosthetic fracture of the femur. J Bone Joint Surg Am 89:2658–2662CrossRefGoogle Scholar
  4. 4.
    Charlson M, Szatrowski TP, Peterson J et al (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251CrossRefGoogle Scholar
  5. 5.
    Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
  6. 6.
    Chen F, Mont MA, Bachner RS (1994) Management of ipsilateral supracondylar femur fractures following total knee arthroplasty. J Arthroplast 9:521–526CrossRefGoogle Scholar
  7. 7.
    De Graaf MW, El Moumni M, Heineman E et al (2015) Short musculoskeletal function assessment: normative data of the Dutch population. Qual Life Res 24:2015–2023CrossRefGoogle Scholar
  8. 8.
    Dennis DA (2001) Periprosthetic fractures following total knee arthroplasty. Instr Course Lect 50:379–389Google Scholar
  9. 9.
    Drew JM, Griffin WL, Odum SM et al (2016) Survivorship after periprosthetic femur fracture: factors affecting outcome. J Arthroplast 31:1283–1288CrossRefGoogle Scholar
  10. 10.
    Drew JM, Griffin WL, Odum SM et al (2015) Survivorship after periprosthetic femur fracture: factors affecting outcome. J ArthroplastGoogle Scholar
  11. 11.
    Ebraheim NA, Kelley LH, Liu X et al (2015) Periprosthetic distal femur fracture after total knee arthroplasty: a systematic review. Orthop Surg 7:297–305CrossRefGoogle Scholar
  12. 12.
    Hoellwarth JS, Fourman MS, Crossett L et al (2018) Equivalent mortality and complication rates following periprosthetic distal femur fractures managed with either lateral locked plating or a distal femoral replacement. Injury 49:392–397CrossRefGoogle Scholar
  13. 13.
    Hoffmann MF, Jones CB, Sietsema DL et al (2012) Outcome of periprosthetic distal femoral fractures following knee arthroplasty. Injury 43:1084–1089CrossRefGoogle Scholar
  14. 14.
    Hoffmann MF, Lotzien S, Schildhauer TA (2016) Clinical outcome of interprosthetic femoral fractures treated with polyaxial locking plates. Injury 47:934–938CrossRefGoogle Scholar
  15. 15.
    Hoffmann MF, Lotzien S, Schildhauer TA (2017) Outcome of periprosthetic femoral fractures following total hip replacement treated with polyaxial locking plate. Eur J Orthop Surg Traumatol 27:107–112CrossRefGoogle Scholar
  16. 16.
    Hunsaker FG, Cioffi DA, Amadio PC et al (2002) The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am 84-A:208–215CrossRefGoogle Scholar
  17. 17.
    Kendall PC, Sheldrick RC (2000) Normative data for normative comparisons. J Consult Clin Psychol 68:767–773CrossRefGoogle Scholar
  18. 18.
    Kim JW, Byun SE, Chang JS (2014) The clinical outcomes of early internal fixation for undisplaced femoral neck fractures and early full weight-bearing in elderly patients. Arch Orthop Trauma Surg 134:941–946CrossRefGoogle Scholar
  19. 19.
    Kristensen O, Nafei A, Kjaersgaard-Andersen P et al (1992) Long-term results of total condylar knee arthroplasty in rheumatoid arthritis. J Bone Joint Surg Br 74:803–806CrossRefGoogle Scholar
  20. 20.
    Kubiak EN, Beebe MJ, North K et al (2013) Early weight bearing after lower extremity fractures in adults. J Am Acad Orthop Surg 21:727–738Google Scholar
  21. 21.
    Kurtz S, Mowat F, Ong K et al (2005) Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 87:1487–1497Google Scholar
  22. 22.
    Kurtz S, Ong K, Lau E et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg 89:780–785Google Scholar
  23. 23.
    Lindahl H (2007) Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury 38:651–654CrossRefGoogle Scholar
  24. 24.
    Mardian S, Schaser KD, Scheel F et al (2015) Quality of life and functional outcome of periprosthetic fractures around the knee following knee arthroplasty. Acta Chir Orthop Traumatol Cech 82:113–118Google Scholar
  25. 25.
    Pritchett JW (1984) Supracondylar fractures of the femur. Clin Orthop Relat Res 184:173–177.  https://doi.org/10.1097/00003086-198404000-00027 Google Scholar
  26. 26.
    Ricci WM (2015) Periprosthetic femur fractures. J Orthop Trauma 29:130–137CrossRefGoogle Scholar
  27. 27.
    Ristevski B, Nauth A, Williams DS et al (2014) Systematic review of the treatment of periprosthetic distal femur fractures. J Orthop Trauma 28:307–312CrossRefGoogle Scholar
  28. 28.
    Ruder JA, Hart GP, Kneisl JS et al (2017) predictors of functional recovery following periprosthetic distal femur fractures. J Arthroplast 32:1571–1575CrossRefGoogle Scholar
  29. 29.
    Shields E, Behrend C, Bair J et al (2014) Mortality and financial burden of periprosthetic fractures of the femur. Geriatr Orthop Surg Rehabil 5:147–153CrossRefGoogle Scholar
  30. 30.
    Smith WR, Stoneback JW, Morgan SJ et al (2016) Is immediate weight bearing safe for periprosthetic distal femur fractures treated by locked plating? A feasibility study in 52 consecutive patients. Patient Saf Surg 10:26CrossRefGoogle Scholar
  31. 31.
    Smith WR, Stoneback JW, Morgan SJ et al (2016) Is immediate weight bearing safe for periprosthetic distal femur fractures treated by locked plating? A feasibility study in 52 consecutive patients. Patient Saf Surg 10:26CrossRefGoogle Scholar
  32. 32.
    Swiontkowski MF, Engelberg R, Martin DP et al (1999) Short musculoskeletal function assessment questionnaire: validity, reliability, and responsiveness. J Bone Joint Surg Am 81:1245–1260CrossRefGoogle Scholar
  33. 33.
    Thukral R, Marya S, Singh C (2015) Management of distal femoral periprosthetic fractures by distal femoral locking plate: a retrospective study. Indian J Orthop 49:199–207CrossRefGoogle Scholar
  34. 34.
    Williams N (2016) The short musculoskeletal function assessment (SMFA) questionnaire. Occup Med (Lond) 66:757CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Sebastian Lotzien
    • 1
    Email author
  • Clemens Hoberg
    • 1
  • Martin F. Hoffmann
    • 1
  • Thomas A. Schildhauer
    • 1
  1. 1.Berufsgenossenschaftliches Universitätsklinikum BergmannsheilBochumGermany

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