Parikh Nihir, Lam Alan D, Hohmann Alexandra L, Lowenstein Natalie A, Warwick Hunter, Fillingham Yale A, Krueger Chad A
Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Arthroplasty. 2025 Sep;40(9S1):S463-S469. doi: 10.1016/j.arth.2025.05.004. Epub 2025 May 12.
Distal femoral replacement (DFR) is a complex reconstruction option for patients who have substantial bone loss, often following multiple failed revision total knee arthroplasties. However, 5-year survivorship after DFR is only 70 to 85%, and there is a paucity of literature evaluating outcomes following revision distal femoral replacements (rDFRs). Therefore, this study aimed to analyze the survivorship and outcomes of rDFR.
This retrospective study identified a consecutive cohort of all patients who underwent DFR at a single institution between 2004 and 2022. Among this population, patients who failed DFR and underwent rDFR were analyzed. All patients had a minimum 2-year follow-up from rDFR. There were 54 patients who underwent rDFR at a mean time of 19.7 months after their index DFR. The primary outcome was reoperation after rDFR. Secondary outcomes included the mechanism of failure, complications, readmission, amputation, and mortality.
Among the 54 patients who underwent rDFR, 22 patients (41%) failed rDFR and had a reoperation. At the most recent follow-up, patients who had rDFRs had a 46% 90-day readmission rate, 9% amputation rate, and 11% mortality rate. The 5-year reoperation-free survivorship after rDFR was 61%. Periprosthetic joint infection was the most common indication for rDFR (43%) and the most common reason for failure of rDFR (59%). Women were significantly associated with the failure of rDFR (P = 0.029).
The outcomes following rDFR are poor, with high reoperation rates, early postoperative failure, complications, and amputation. These outcomes and risks should be shared with patients when discussing limb salvage options before these operations.
对于那些通常在多次全膝关节置换翻修失败后出现大量骨质流失的患者，股骨远端置换术（DFR）是一种复杂的重建选择。然而，DFR术后5年的生存率仅为70%至85%，并且评估翻修股骨远端置换术（rDFR）后结果的文献很少。因此，本研究旨在分析rDFR的生存率和结果。
这项回顾性研究确定了2004年至2022年期间在单一机构接受DFR的所有患者的连续队列。在该人群中，分析了DFR失败并接受rDFR的患者。所有患者自rDFR后至少随访2年。有54例患者在初次DFR后平均19.7个月接受了rDFR。主要结局是rDFR后的再次手术。次要结局包括失败机制、并发症、再次入院、截肢和死亡率。
在接受rDFR的54例患者中，22例（41%）rDFR失败并再次手术。在最近一次随访时，接受rDFR的患者90天再次入院率为46%，截肢率为9%，死亡率为11%。rDFR后5年无再次手术生存率为61%。假体周围关节感染是rDFR最常见的指征（43%），也是rDFR失败最常见的原因（59%）。女性与rDFR失败显著相关（P = 0.029）。
rDFR后的结果较差，再次手术率高，术后早期失败、并发症和截肢情况较多。在这些手术前讨论保肢方案时，应将这些结果和风险告知患者。
