Introduction: Periprosthetic fractures are an infrequent but increasingly prevalent problem and can be technically difficult to manage. Various techniques have been described to manage periprosthetic supracondylar fractures around a Total Knee Replacement (TKR) including, immobilisation, plate fixation, rush rods, LISS (less invasive stabilisation system) and retrograde nailing. The aim of this retrospective study was to evaluate the effectiveness of the retrograde intramedullary nail.

Methods: We identified all patients who underwent retrograde intramedullary nail for the treatment of periprosthetic femoral fractures between January 1999 and October 2005. Notes, x-rays and operation data were examined retrospectively. Outcomes were measured by radiological union, limb alignment, return to function, pain and complications.

Results: Of the 15 patients 2 died of coexisting medical problems during the follow-up period, but both with good fracture alignment. 13 united between 12 – 24 weeks (mean 15 weeks), 11 regained pre-injury function with alignment good in 12. 12 were pain free at follow-up, 2 patients required non-steroidal analgesia intermittently. There was one delayed union (53 weeks). There was one post operative complication where a patient with bilateral fractures required one night stay on ITU.

Conclusion: Intramedullary nailing of periprosthetic fractures around a TKR gave excellent functional results and 100% union in this series.