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
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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 133:921–927
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 22:2690–2697
Bezwada HP, Neubauer P, Baker J, Israelite CL, Johanson NA (2004) Periprosthetic supracondylar femur fractures following total knee arthroplasty. J Arthroplasty 19:453–458
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 17:876–881
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 33:981–985
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 19:1473–1478
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 13:401–406
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 5:124–128
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 15:201–207
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 26:27–32
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 79:22–27
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–e566
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 26:427–432
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 19:156–162
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 79:417–421
Large TM, Kellam JF, Bosse MJ, Sims SH, Althausen P, Masonis JL (2008) Locked plating of supracondylar periprosthetic femur fractures. J Arthroplasty 23:115–120
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 134:47–52
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 36:2441–2446
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]
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 39:1737–1742
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 29:1478–1481
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:114–121
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 27:158–161
Ricci WM (2015) Periprosthetic femur fractures. J Orthop Trauma 29:130–137
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 28:307–312
Thukral R, Marya S, Singh C (2015) Management of distal femoral periprosthetic fractures by distal femoral locking plate: a retrospective study. Indian J Orthop 49:199–207
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 107:181–188
Yoo JD, Kim NK (2015) Periprosthetic fractures following total knee arthroplasty. Knee Surg Relat Res 27:1–9
Young-Soo Shin and Hyun-Jung Kim have contributed equally to this work.
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Shin, Y., Kim, H. & Lee, D. 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
- Total knee arthroplasty
- Periprosthetic fracture
- Distal femur
- Locking plate
- Intramedullary nail