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Treatment of periprosthetic femoral fractures of the knee

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

Abstract

Purpose

We report a continuous series of periprosthetic femoral fractures after knee arthroplasty treated with a locking plate. We hypothesize that minimally invasive surgery and immediate weight-bearing improve functional recovery.

Methods

From June 2002 to December 2008, 15 patients with 16 fractures were treated. Median age was 81 years. The autonomy level according to the mobility score of Parker and Palmer showed a median of 5 (0–9). Osteosynthesis was performed mainly through a minimally invasive approach using a locking compression plate. The rehabilitation protocol consisted of immediate mobilization and, whenever possible, immediate unrestricted weight-bearing.

Results

Five patients died during follow-up, more than 1 year after osteosynthesis. Their results were included. Autonomy and mobility were preserved with a median postoperative score of 4 (0–9) according to Parker and Palmer. The consolidation rate was 93.8%, which was obtained within 10 weeks. There were no mechanical or infectious complications. Fourteen cases were treated with minimally invasive surgery without fracture exposition; the remaining 2 required a slightly more extended approach. Full weight-bearing occurred 10 times; 20-kg partial weight-bearing was advised twice; and on 4 occasions, no weight-bearing was allowed for 6 weeks.

Conclusion

Osteosynthesis with a minimally invasive bridge-plating technique is effective in the treatment of periprosthetic, distal femoral fractures without component loosening. Immediate full weight-bearing is possible if certain rules are respected. The surgical management presented herein is beneficial for these challenging fractures, and it may help reduce the complication rate and improve functional outcome.

Level of evidence

IV.

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Conflict of interest

ME and PA: consulting activity, no financial conflict for this study. LA, MR, BKM, YA, BF: none.

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Authors and Affiliations

  1. Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg cedex, France

    Matthieu Ehlinger, Philippe Adam, Lamine Abane, Michel Rahme & François Bonnomet

  2. Service de Chirurgie Orthopédique et de Traumatologie, Hôpital du Valais CHCVs, 80 av Grand Champsec, 1950, Sion, Switzerland

    Beat Kaspar Moor & Yvan Arlettaz

Authors
  1. Matthieu Ehlinger
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  2. Philippe Adam
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  3. Lamine Abane
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  4. Michel Rahme
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  5. Beat Kaspar Moor
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  6. Yvan Arlettaz
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  7. François Bonnomet
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Correspondence to Matthieu Ehlinger.

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Ehlinger, M., Adam, P., Abane, L. et al. Treatment of periprosthetic femoral fractures of the knee. Knee Surg Sports Traumatol Arthrosc 19, 1473–1478 (2011). https://doi.org/10.1007/s00167-011-1480-6

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  • DOI: https://doi.org/10.1007/s00167-011-1480-6

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