Outcome and incidence of periprosthetic supracondylar femoral fractures in TKA.

BACKGROUND

Periprosthetic supracondylar femoral fractures following total knee arthroplasty (TKA) are infrequent, but is a devastating complication. The purpose of this study was to evaluate the incidence and outcomes of periprosthetic supracondylar femoral fractures following TKA using nonoperative as well as open reduction and internal fixation (ORIF) techniques.

MATERIALS AND METHODS

Between January 2004 and December 2010, we followed 3,920 operated patients of total knee arthroplasty (TKA) and identified 23 patients with periprosthetic supracondylar fractures. A retrospective analysis of the records of these patients was conducted. Details regarding pre fracture status, treatment offered and the present status were also recorded and analyzed. Time from index arthroplasty to periprosthetic fracture ranged from five days to six years. There were 17 women and 6 men and the average age was 68.26 years (range 52-83 years). Of the 23 patients, 20 patients were treated by operative method, whereas only three patients with relatively undisplaced fractures were treated nonoperatively.

RESULTS

The total incidence of periprosthetic fractures in operated cases of TKA was 0.58%. Three patients had infection after surgery. As per radiological assessment, two of three conservatively treated cases had malunion, whereas among 20 cases treated operatively, 16 had primary union with one malunion. Two patients had union after bone grafting, whereas two had nonunion. The average reduction in the knee score after fracture was 20.53%. Twenty one patients were able to achieve limited but independent activity.

CONCLUSIONS

Desirable results for periprosthetic fractures can be obtained if proper and timely intervention is done, taking into account the other comorbid conditions. However, short duration of followup and small number of patients were major limiting factors in this study.