HSS Journal ®

, Volume 10, Issue 1, pp 68–72 | Cite as

Coupling Device and Distal Femoral Replacement for Periprosthetic Supracondylar Femur Fractures with an Ipsilateral Total Knee and Hip Replacement

  • Matthew J. Grosso
  • Joseph Lipman
  • Mathias P. Bostrom
Surgical Technique



Periprosthetic supracondylar fractures in the setting of an ipsilateral total knee and hip replacement are a rare but serious orthopedic challenge.

Description of Technique

In this unique situation, we consider insertion of a custom coupling device with a distal femoral replacement as an appropriate surgical solution that allows for stability and preserves hip and knee functionality, while not relying on the poor healing potential of the remaining intercalary femoral bone.

Patients and Methods

We report the outcomes of two patients who underwent this custom coupling procedure.


These custom devices resulted in successful outcomes with restoration of ambulatory function and range of motion at greater than 14 months follow-up.


We found that this technique provides sufficient stability and preserves functionality in a difficult-to-treat patient population. The results indicate that this technique may be considered as an alternative to more invasive procedures including total femoral replacement and complete femoral allograft constructs.


periprosthetic fracture coupling device femoral replacement total knee replacement total hip replacement 

Supplementary material

11420_2013_9360_MOESM1_ESM.pdf (511 kb)
ESM 1(PDF 510 kb)
11420_2013_9360_MOESM2_ESM.pdf (511 kb)
ESM 2(PDF 510 kb)
11420_2013_9360_MOESM3_ESM.pdf (511 kb)
ESM 3(PDF 510 kb)


  1. 1.
    Berend KR, Lombardi AV Jr, Mallory TH, Adams JB, Dodds KL. Total femoral arthroplasty for salvage of end-stage prosthetic disease. Clin Orthop Relat Res. 2004; 427: 162-170.PubMedCrossRefGoogle Scholar
  2. 2.
    Foster TE, Healy WL. Operative management of distal femoral fractures. Orthop Rev. 1991; 20(11): 962-969.PubMedGoogle Scholar
  3. 3.
    Jabczenski FF, Crawford M. Retrograde intramedullary nailing of supracondylar femur fractures above total knee arthroplasty. A preliminary report of four cases J Arthroplasty. 1995; 10(1): 95-101.Google Scholar
  4. 4.
    Kraay MJ, Goldberg VM, Figgie MP, Figgie HE 3rd. Distal femoral replacement with allograft/prosthetic reconstruction for treatment of supracondylar fractures in patients with total knee arthroplasty. J Arthroplasty. 1992; 7(1): 7-16.PubMedCrossRefGoogle Scholar
  5. 5.
    Kregor PJ, Hughes JL, Cole PA. Fixation of distal femoral fractures above total knee arthroplasty utilizing the Less Invasive Stabilization System (L.I.S.S.). Injury. 2001; 32(Suppl 3): SC64-75.PubMedCrossRefGoogle Scholar
  6. 6.
    Kurtz S, Mowat F, Ong K, et al. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005; 87(7): 1487-1497.PubMedCrossRefGoogle Scholar
  7. 7.
    Lachiewicz PF. Periprosthetic fracture between a constrained total knee arthroplasty and a long-stem total hip arthroplasty: treatment with a novel device. J Arthroplasty. 2007; 22(3): 449-452.PubMedCrossRefGoogle Scholar
  8. 8.
    McGraw P, Kumar A. Periprosthetic fractures of the femur after total knee arthroplasty. J Orthop Traumatol. 2010; 11(3): 135-141.PubMedCrossRefGoogle Scholar
  9. 9.
    Mortazavi SMJ, Kurd MF, Bender B, et al. Distal femoral arthroplasty for the treatment of periprosthetic fractures after total knee arthroplasty. J Arthroplasty. 2010; 25(5): 775-780.PubMedCrossRefGoogle Scholar
  10. 10.
    Osagie LE, Bostrom MPG. A custom coupling device of total knee and ipsilateral total hip arthroplasties after distal femoral fracture. J Arthroplasty. 2011; 26(8): 1571.e1-3.CrossRefGoogle Scholar
  11. 11.
    Peters CL, Hickman JM, Erickson J, et al. Intramedullary total femoral replacement for salvage of the compromised femur associated with hip and knee arthroplasty. J Arthroplasty. 2006; 21(1): 53-58.PubMedCrossRefGoogle Scholar
  12. 12.
    Smith WJ, Martin SL, Mabrey JD. Use of a supracondylar nail for treatment of a supracondylar fracture of the femur following total knee arthroplasty. J Arthroplasty. 1996; 11(2): 210-213.PubMedCrossRefGoogle Scholar
  13. 13.
    Tillman R, Kalra S, Grimer R, Carter S, Abudu A. A custom-made prosthesis attached to an existing femoral component for the treatment of peri- and sub-prosthetic fracture. J Bone Joint Surg Br. 2006; 88(10): 1299-1302.PubMedCrossRefGoogle Scholar
  14. 14.
    Urch SE, Moskal JT. Simultaneous ipsilateral revision total hip arthroplasty and revision total knee arthroplasty with entire femoral allograft. J Arthroplasty. 1998; 13(7): 833-836.PubMedCrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2013

Authors and Affiliations

  • Matthew J. Grosso
    • 1
    • 2
  • Joseph Lipman
    • 1
  • Mathias P. Bostrom
    • 1
  1. 1.Hospital for Special SurgeryNew YorkUSA
  2. 2.Cleveland Clinic Lerner College of MedicineCleveland ClinicClevelandUSA

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