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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

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.

Methods

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.

Results

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.).

Conclusions

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

II.

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Author notes

    Authors and Affiliations

    1. Department of Orthopedic Surgery, Seoul Veterans Hospital, Seoul, Korea

      Young-Soo Shin

    2. Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea

      Hyun-Jung Kim

    3. Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Korea

      Dae-Hee Lee

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    1. Young-Soo Shin
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    2. Hyun-Jung Kim
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    Correspondence to Dae-Hee Lee.

    Additional information

    Young-Soo Shin and Hyun-Jung Kim have contributed equally to this work.

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    Shin, YS., Kim, HJ. & Lee, DH. Similar outcomes of locking compression plating and retrograde intramedullary nailing for periprosthetic supracondylar femoral fractures following total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 25, 2921–2928 (2017). https://doi.org/10.1007/s00167-016-4050-0

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