Supracondylar fractures of the femur adjacent to resurfacing and MacIntosh arthroplasties of the knee in patients with rheumatoid arthritis.

Twelve cases of supracondylar fracture of the femur in rheumatoid arthritis patients with previously implanted resurfacing or MacIntosh arthroplasty of the knee had long standing severe polyarticular rheumatoid arthritis (duration, ten to 41 years; mean 24.8 years). The fractures occurred following a long interval after implantation of the prosthesis (five to 204 months; mean, 92.3 months). Two fractures were treated by stable and two by unstable fixation; eight were treated nonoperatively. The fractures healed in a normal time with one exception, but the femur was shortened in ten cases (mean, 2.8 cm), and axially malaligned in nine. The ability to walk long distances decreased in eight cases and pain increased in seven; two prostheses were loosened and displaced. Because of the poor results of nonoperative management, internal fixation of these fractures is recommended in selected cases.