Management of Distal Femur Periprosthetic Fracture in Elderly Patient with Distal Femur Replacement: Case Series

Background:
Periprosthetic distal femur fractures (PDFF) after total knee arthroplasty are a relatively rare complication but a very complex one with a high morbidity rate. It’s a big challenge to the orthopedic surgeon regarding choice of treatment and increased morbidity and mortality post-operatively.

Non-operative treatment is quite rare. The operative treatment choice and success depends on several factors including patient’s bone stock quality, implant’s stability, fracture pattern and patient’s co-morbidities and level of function. Open Reduction and Internal Fixation (ORIF) in several techniques is one of the options. Retrograde Nailing is another one. Distal Femur Replacement (DFR) and Allograft Prosthetic Composite (APC) are options which are saved with those patients with a poor bone stock quality.

Methods:
We retrospectively examined the medical records of 7 low functioning patients with displaced PDFF (Lewis and Roreback type III) who were treated with DFR.

Results:
85% of the patients received primary treatment with DFR. One patient had a failed non-operative treatment after she was medically unfit for surgery (ARDS due to COVID-19). Our mean follow-up time is 10.67 month. Major complications include one immediate post op mortality and one case of Pulmonary Embolism. Other complications include superficial wound infection (1), aseptic loosening of the femoral component (1) and a subtrochanteric fracture (1).

Conclusion:
We believe offers a good solution for low functioning patients with a PDFR and poor femur bone stock quality.