Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY.
J Arthroplasty. 2021 Jul;36(7S):S351-S357. doi: 10.1016/j.arth.2020.12.037. Epub 2020 Dec 26.
There is a paucity of data on the outcomes of distal femoral replacements (DFRs) in patients with total knee arthroplasty (TKA) periprosthetic fractures. We sought to characterize these patients' survivorship free from rerevision.
We retrospectively identified 49 patients, including 34 after primary TKA (primary cohort), 9 after revision TKA, and 6 conversions for failed open reduction and internal fixation (revision cohort) that underwent DFR for a periprosthetic femur fracture. The mean age was 76 years, and 40 patients (82%) were female. The mean follow-up was 4 years. Femoral fixation included 44 cemented stems (90%) and 5 cementless stems (10%). Survivorship free from rerevision was characterized by the Kaplan-Meier method; cox proportional regression was used to analyze the risk factors for rerevision.
Survivorship free from any rerevision at 5 years in the primary and revision cohort was 93% and 18%, respectively. The revision cohort had a 5.3× higher risk of re-revision (P = .008). Survivorship free from re-revision for aseptic loosening at 5 years in the primary and revision cohort was 93% and 53%, respectively. Two of the 3 patients with cementless stems in the primary cohort underwent early rerevision for aseptic loosening, but patients with prior primary TKAs treated with cemented femoral fixation (n = 31) had a 97% 5-year survivorship free from re-revision.
Patients with periprosthetic fractures around prior primary TKAs treated with DFRs with cemented femoral fixation had a 97% 5-year survivorship free from any re-revision. DFRs for periprosthetic femur fractures around revision TKAs or conversions of failed open reduction and internal fixations have a 5× increased risk of rerevision.
全膝关节置换术后假体周围股骨骨折的远端股骨置换（DFR）的结果数据较少。我们试图对这些患者进行特征描述，以避免再次翻修。
我们回顾性地确定了 49 名患者，包括 34 名初次 TKA 后（初次队列），9 名翻修 TKA 后，6 名失败的切开复位内固定（修正队列）患者接受 DFR 治疗假体周围股骨骨折。平均年龄为 76 岁，40 名患者（82%）为女性。平均随访时间为 4 年。股骨固定包括 44 个骨水泥柄（90%）和 5 个非骨水泥柄（10%）。采用 Kaplan-Meier 法评估无再次翻修的生存率；采用 Cox 比例回归分析再次翻修的风险因素。
初次和修正队列的 5 年无任何再次翻修生存率分别为 93%和 18%。修正队列再次翻修的风险高 5.3 倍（P=0.008）。初次和修正队列的 5 年无菌性松动无再次翻修生存率分别为 93%和 53%。初次队列中的 3 名非骨水泥柄患者中有 2 例因无菌性松动而早期再次翻修，但先前初次 TKA 采用骨水泥固定股骨的 31 例患者的 5 年无再次翻修生存率为 97%。
初次 TKA 假体周围骨折患者采用骨水泥固定股骨的 DFR 治疗，5 年无任何再次翻修的生存率为 97%。初次 TKA 或失败切开复位内固定的翻修患者的 DFR 有 5 倍的再次翻修风险。
