Eur J Orthop Surg Traumatol. 2025 Nov 29;36(1):28. doi: 10.1007/s00590-025-04584-y.
ABSTRACT
INTRODUCTION: We investigated outcomes of patients treated with either locked plating or retrograde intramedullary nailing (IMN) at a single institution and compared outcomes of retrograde IMN to locked plating for periprosthetic distal femur fractures.
METHODS: We reviewed 241 subjects with distal femur fractures around total knee arthroplasty (TKA) treated with locked plating (197) or retrograde IMN (44). Mean age was 77 years, 78% were female, and mean BMI was 32 kg/m2. There were 27% Su I, 41% Su II, and 32% Su III fractures. There were 87% primary TKAs and 13% revision TKAs. Mean follow-up was 3 years.
RESULTS: Overall nonunion rate was 10% and 5-year survivorship free of any revision was 81%, with the most common reasons being nonunion (49%), infection (19%), and aseptic TKA loosening (11%). Patients with prior TKA infection (HR 3; p = 0.02), revision TKA (HR 2; p = 0.03), Su III fractures (HR 2.5; p = 0.04) were at increased risk of revision. There was a trend toward higher non-union rate in the locked plating group (11% vs. 2%; p = 0.07). Those with locked plating had higher rates of osteoporosis (70% vs. 52%; p = 0.02), prior revision TKA (16% vs. 2%; p = 0.02), and Su Type III fractures (36% vs.16%, p = 0.047). Five-year survivorship free of any revision for locked plating and retrograde IMN were 80% and 84%, respectively, with no significant difference in revision, reoperation, or non-operative complications.
CONCLUSIONS: Both locked plating and retrograde IMN are viable fixation options for periprosthetic distal femur fractures after TKA. Those treated with locked plating had higher rates of osteoporosis, prior revision TKA, and more distal fractures, but did not demonstrate a significant increased risk for reoperation or revision.
LEVEL OF EVIDENCE: Level III, Retrospective comparative cohort study.
PMID:41317180 | DOI:10.1007/s00590-025-04584-y
