Abstract
Periprosthetic distal femoral fractures (PDFF) constitute an unpleasant complication in patients with a total knee replacement (TKR). The incidence reported in literature is 0.3-2.5 %.
The number of periprosthetic knee fractures has been increasing due to the ageing of population, a growing number of implants, a longer life expectancy of patients, a more intensive physical activity of patients, and osteoporosis. Most of these fractures are treated surgically, non-surgical treatment is reserved solely for patients unable to undergo a surgery for general health conditions.
Our retrospective study evaluated the group of patients with PDFF who were treated at out department in the period 2007-2016 and 2,975 primary TKR were performed. The total number of patients with PDFF was 56.
The mean age of patients with PDFF was 77 years (56-94 years) and at the time of fracture the mean age was 71 years in men and 78 years in women. The average time from the TKR to periprosthetic fracture was 8.2 years (0-20 years).
The fractures were assessed using the Su classification modified by Krbec. A primary TKR was performed in 46 cases for gonarthrosis, in 6 cases for rheumatoid arthritis and in 4 cases for secondary, post-traumatic gonarthrosis.
The average incidence of periprosthetic distal femoral fractures was 5-6 cases per year. Women represented 86 %, men 14 %.
Su Type I fracture was diagnosed in 25 % of cases, Su Type II fractures in 71 %, and Su Type III fractures 4 %. 52 patients with PDFF were treated surgically, in 4 cases conservative treatment was opted for. The average treatment time of PDFF to healing by callus formation was 6.6 months (3-12 months).
Mortality during the first 3 months after osteosynthesis of PDFF was 9 %. A failure of osteosynthesis of PDFF was reported in 4 cases.