Advertisement for orthosearch.org.uk
Results 1 - 14 of 14
Results per page:
The Bone & Joint Journal
Vol. 103-B, Issue 4 | Pages 635 - 643
1 Apr 2021
Ross LA Keenan OJF Magill M Brennan CM Clement ND Moran M Patton JT Scott CEH

Aims. Debate continues regarding the optimum management of periprosthetic distal femoral fractures (PDFFs). This study aims to determine which operative treatment is associated with the lowest perioperative morbidity and mortality when treating low (Su type II and III) PDFFs comparing lateral locking plate fixation (LLP-ORIF) or distal femoral arthroplasty (DFA). Methods. This was a retrospective cohort study of 60 consecutive unilateral (PDFFs) of Su types II (40/60) and III (20/60) in patients aged ≥ 60 years: 33 underwent LLP-ORIF (mean age 81.3 years (SD 10.5), BMI 26.7 (SD 5.5); 29/33 female); and 27 underwent DFA (mean age 78.8 years (SD 8.3); BMI 26.7 (SD 6.6); 19/27 female). The primary outcome measure was reoperation. Secondary outcomes included perioperative complications, calculated blood loss, transfusion requirements, functional mobility status, length of acute hospital stay, discharge destination and mortality. Kaplan-Meier survival analysis was performed. Cox multivariate regression analysis was performed to identify risk factors for reoperation after LLP-ORIF. Results. Follow-up was at mean 3.8 years (1.0 to 10.4). One-year mortality was 13% (8/60). Reoperation was more common following LLP-ORIF: 7/33 versus 0/27 (p = 0.008). Five-year survival for reoperation was significantly better following DFA; 100% compared to 70.8% (95% confidence interval (CI) 51.8% to 89.8%, p = 0.006). There was no difference for the endpoint mechanical failure (including radiological loosening); ORIF 74.5% (56.3 to 92.7), and DFA 78.2% (52.3 to 100, p = 0.182). Reoperation following LLP-ORIF was independently associated with medial comminution; hazard ratio (HR) 10.7 (1.45 to 79.5, p = 0.020). Anatomical reduction was protective against reoperation; HR 0.11 (0.013 to 0.96, p = 0.046). When inadequately fixed fractures were excluded, there was no difference in five-year survival for either reoperation (p = 0.156) or mechanical failure (p = 0.453). Conclusion. Absolute reoperation rates are higher following LLP fixation of low PDFFs compared to DFA. Where LLP-ORIF was well performed with augmentation of medial comminution, there was no difference in survival compared to DFA. Though necessary in very low fractures, DFA should be used with caution in patients with greater life expectancies due to the risk of longer term aseptic loosening. Cite this article: Bone Joint J 2021;103-B(4):635–643


Bone & Joint Open
Vol. 5, Issue 6 | Pages 489 - 498
12 Jun 2024
Kriechling P Bowley ALW Ross LA Moran M Scott CEH

Aims. The purpose of this study was to compare reoperation and revision rates of double plating (DP), single plating using a lateral locking plate (SP), or distal femoral arthroplasty (DFA) for the treatment of periprosthetic distal femur fractures (PDFFs). Methods. All patients with PDFF primarily treated with DP, SP, or DFA between 2008 and 2022 at a university teaching hospital were included in this retrospective cohort study. The primary outcome was revision surgery for failure following DP, SP, or DFA. Secondary outcome measures included any reoperation, length of hospital stay, and mortality. All basic demographic and relevant implant and injury details were collected. Radiological analysis included fracture classification and evaluation of metaphyseal and medial comminution. Results. A total of 111 PDFFs (111 patients, median age 82 years (interquartile range (IQR) 75 to 88), 86% female) with 32 (29%) Su classification 1, 37 (34%) Su 2, and 40 (37%) Su 3 fractures were included. The median follow-up was 2.5 years (IQR 1.2 to 5.0). DP, SP, and DFA were used in 15, 66, and 30 patients, respectively. Compared to SP, patients treated with DP were more likely to have metaphyseal comminution (47% vs 14%; p = 0.009), to be low fractures (47% vs 11%; p = 0.009), and to be anatomically reduced (100% vs 71%; p = 0.030). Patients selected for DFA displayed comparable amounts of medial/metaphyseal comminution as those who underwent DP. At a minimum follow-up of two years, revision surgery for failure was performed in 11 (9.9%) cases at a median of five months (IQR 2 to 9): 0 DP patients (0%), 9 SP (14%), and 2 DFA (6.7%) (p = 0.249). Conclusion. Using a strategy of DP fixation in fractures, where the fracture was low but there was enough distal bone to accommodate locking screws, and where there is metaphyseal comminution, resulted in equivalent survival free from revision or reoperation compared to DFA and SP fixation. Cite this article: Bone Jt Open 2024;5(6):489–498


Bone & Joint Open
Vol. 3, Issue 3 | Pages 173 - 181
1 Mar 2022
Sobol KR Fram BR Strony JT Brown SA

Aims. Endoprosthetic reconstruction with a distal femoral arthroplasty (DFA) can be used to treat distal femoral bone loss from oncological and non-oncological causes. This study reports the short-term implant survivorship, complications, and risk factors for patients who underwent DFA for non-neoplastic indications. Methods. We performed a retrospective review of 75 patients from a single institution who underwent DFA for non-neoplastic indications, including aseptic loosening or mechanical failure of a previous prosthesis (n = 25), periprosthetic joint infection (PJI) (n = 23), and native or periprosthetic distal femur fracture or nonunion (n = 27). Patients with less than 24 months’ follow-up were excluded. We collected patient demographic data, complications, and reoperations. Reoperation for implant failure was used to calculate implant survivorship. Results. Overall one- and five-year implant survivorship was 87% and 76%, respectively. By indication for DFA, mechanical failure had one- and five-year implant survivorship of 92% and 68%, PJI of 91% and 72%, and distal femur fracture/nonunion of 78% and 70% (p = 0.618). A total of 37 patients (49%) experienced complications and 27 patients (36%) required one or more reoperation. PJI (n = 16, 21%), aseptic loosening (n = 9, 12%), and wound complications (n = 8, 11%) were the most common complications. Component revision (n = 10, 13.3%) and single-stage exchange for PJI (n = 9, 12.0 %) were the most common reoperations. Only younger age was significantly associated with increased complications (mean 67 years (SD 9.1)) with complication vs 71 years (SD 9.9) without complication; p = 0.048). Conclusion. DFA is a viable option for distal femoral bone loss from a range of non-oncological causes, demonstrating acceptable short-term survivorship but with high overall complication rates. Cite this article: Bone Jt Open 2022;3(3):173–181


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 7 - 7
1 Jul 2022
Hassan AR Lee-A-Ping K Pegrum J Dodds A
Full Access

Abstract. Introduction. Distal Femoral Fractures around a Total Knee Replacement have a reported incidence of 0.25–2.3% of primary TKRs. Literature suggests that these fractures have high complication rates such as non union and revision. Methodology. A retrospective case note review was undertaken of all patients who sustained a distal femoral fracture around a TKR from April 2014-April 2021. Data parameters collected included patient demographics, classification of fracture, management, post op mobility, fracture union and mortality. Results. 52 distal femoral fractures were recorded, out of which 5 patients had bilateral fractures. The average age was 83.6 years (61–101). 41 fractures were managed operatively with 61% undergoing ORIF, 37% undergoing Distal Femoral Replacement & 2% undergoing a retrograde IM Nail. The median LOS was 22 days (11–85) for patients treated with DFR versus 10 (3–75) for those undergoing an ORIF. 60% of DFR patients were discharged home compared to 56% of those who underwent an ORIF. All the DFR patients were FWB post op compared to ORIF 24%. Conclusion. Over a 7 year study period, 52 distal femoral fractures were reviewed. Despite FWB status post op, patients undergoing a DFR had a longer length of stay and less were discharged home compared to the ORIF group. Given the cost of a distal femoral replacement (£4485-6500) compared to £212-297 for a locking plate, in order to get patients FWB post operatively potentially dual plating (medial and lateral) may need to be considered if the fracture is amenable to improve stability & allow FWB


Bone & Joint Open
Vol. 4, Issue 10 | Pages 808 - 816
24 Oct 2023
Scott CEH Snowden GT Cawley W Bell KR MacDonald DJ Macpherson GJ Yapp LZ Clement ND

Aims

This prospective study reports longitudinal, within-patient, patient-reported outcome measures (PROMs) over a 15-year period following cemented single radius total knee arthroplasty (TKA). Secondary aims included reporting PROMs trajectory, 15-year implant survival, and patient attrition from follow-up.

Methods

From 2006 to 2007, 462 consecutive cemented cruciate-retaining Triathlon TKAs were implanted in 426 patients (mean age 69 years (21 to 89); 290 (62.7%) female). PROMs (12-item Short Form Survey (SF-12), Oxford Knee Score (OKS), and satisfaction) were assessed preoperatively and at one, five, ten, and 15 years. Kaplan-Meier survival and univariate analysis were performed.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 77 - 77
1 Mar 2012
James AR Dean B Moore E Whitwell D Price A Gibbons C
Full Access

Aim. A case series with functional and radiographic outcomes, of modular endoprosthetic distal femoral replacement in complex cases of periprosthetic fracture. Method. Sixteen cases were identified of endoprosthetic replacement (EPR) from the bone and soft tissue cancer implant registry. A retrospective review was undertaken. Results. There were 11 periprosthetic fractures of total knee arthroplasty, 3 revision arthroplasty cases, and 3 cases of distal femoral fracture. Of which four were complicated by infection. AKSS scores ranged from 62-100, average 82, with 6 month minimum follow up. There were two post operative infections, both successfully treated. One femoral component required exchange for aseptic loosening at two years. Conclusion. EPR is an effective surgical procedure for complex cases with a demonstrable good functional outcome


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 63 - 63
1 Mar 2012
Fetherston CR Chapman-Sheath P Tice JW
Full Access

This study looks at the use of rotating hinge Total Knee Replacement (TKR) as a treatment option when dealing with fractures involving the knee. The treatment of complex intra-articular fractures involving the knee has always proved challenging. Studies have investigated the outcome of various forms of treatment for such injuries, including internal fixation and primary knee arthroplasty. Recent advances in technology have brought about more sophisticated implants for both internal fixation and arthroplasty, including rotating hinge TKR. The initial non-rotating hinged prostheses for total knee arthroplasty did not enjoy a good reputation. The cumulative survival rate has been quoted as 65% at 6 years, significantly lower than that of conventional prostheses. Therefore the use of such implants was restricted to complex primary or revision arthroplasty, and tumour surgery. Studies have been published advocating the use of hinged prostheses for distal femoral fractures in elderly patients. The average age in the most recent study was 82, of whom 42% had died within the first post-operative year. This study is a case series of 16 patients with fractures who were treated with rotating hinge TKR. The age range is 36 to 92, with a mean of 69, lower than that of earlier studies. Outcome data as measured by the Oxford knee scoring system has been retrospectively collected. At follow up the range of Oxford knee scores was 14 to 52, with a mean of 36. We discuss the indications, experiences and outcomes in the management of these patients, and conclude that this is a valid treatment option in certain circumstances


The Bone & Joint Journal
Vol. 103-B, Issue 6 Supple A | Pages 158 - 164
1 Jun 2021
Hernandez NM Hinton ZW Wu CJ Ryan SP Bolognesi MP

Aims

Tibial cones are often utilized in revision total knee arthroplasty (TKA) with metaphyseal defects. Because there are few studies evaluating mid-term outcomes with a sufficient cohort, the purpose of this study was to evaluate tibial cone survival and complications in revision TKAs with tibial cones at minimum follow-up of five years.

Methods

A retrospective review was completed from September 2006 to March 2015, evaluating 67 revision TKAs (64 patients) that received one specific porous tibial cone during revision TKA. The final cohort was composed of 62 knees (59 patients) with five years of clinical follow-up or reoperation. The mean clinical follow-up of the TKAs with minimum five-year clinical follow-up was 7.6 years (5.0 to 13.3). Survivorship analysis was performed with the endpoints of tibial cone revision for aseptic loosening, tibial cone revision for any reason, and reoperation. We also evaluated periprosthetic joint infection (PJI), risk factors for failure, and performed a radiological review.


The Bone & Joint Journal
Vol. 102-B, Issue 6 Supple A | Pages 107 - 115
1 Jun 2020
Tetreault MW Perry KI Pagnano MW Hanssen AD Abdel MP

Aims

Metaphyseal fixation during revision total knee arthroplasty (TKA) is important, but potentially difficult when using historical designs of cone. Material and manufacturing innovations have improved the size and shape of the cones which are available, and simplified the required bone preparation. In a large series, we assessed the implant survivorship, radiological results, and clinical outcomes of new porous 3D-printed titanium metaphyseal cones featuring a reamer-based system.

Methods

We reviewed 142 revision TKAs in 139 patients using 202 cones (134 tibial, 68 femoral) which were undertaken between 2015 and 2016. A total of 60 involved tibial and femoral cones. Most cones (149 of 202; 74%) were used for Type 2B or 3 bone loss. The mean age of the patients was 66 years (44 to 88), and 76 (55 %) were female. The mean body mass index (BMI) was 34 kg/m2 (18 to 60). The patients had a mean of 2.4 (1 to 8) previous operations on the knee, and 68 (48%) had a history of prosthetic infection. The mean follow-up was 2.4 years (2 to 3.6).


The Bone & Joint Journal
Vol. 101-B, Issue 1_Supple_A | Pages 46 - 52
1 Jan 2019
León SA Mei XY Safir OA Gross AE Kuzyk PR

Aims

The aim of this study was to report the outcome of femoral condylar fresh osteochondral allografts (FOCA) with concomitant realignment osteotomy with a focus on graft survivorship, complications, reoperation, and function.

Patients and Methods

We identified 60 patients (16 women, 44 men) who underwent unipolar femoral condylar FOCA with concomitant realignment between 1972 and 2012. The mean age of the patients was 28.9 years (10 to 62) and the mean follow-up was 11.4 years (2 to 35). Failure was defined as conversion to total knee arthroplasty, revision allograft, or graft removal. Clinical outcome was evaluated using the modified Hospital for Special Surgery (mHSS) score.


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 9 | Pages 1160 - 1169
1 Sep 2012
Bohm ER Tufescu TV Marsh JP

This review considers the surgical treatment of displaced fractures involving the knee in elderly, osteoporotic patients. The goals of treatment include pain control, early mobilisation, avoidance of complications and minimising the need for further surgery. Open reduction and internal fixation (ORIF) frequently results in loss of reduction, which can result in post-traumatic arthritis and the occasional conversion to total knee replacement (TKR). TKR after failed internal fixation is challenging, with modest functional outcomes and high complication rates. TKR undertaken as treatment of the initial fracture has better results to late TKR, but does not match the outcome of primary TKR without complications. Given the relatively infrequent need for late TKR following failed fixation, ORIF is the preferred management for most cases. Early TKR can be considered for those patients with pre-existing arthritis, bicondylar femoral fractures, those who would be unable to comply with weight-bearing restrictions, or where a single definitive procedure is required.


The Bone & Joint Journal
Vol. 97-B, Issue 2 | Pages 192 - 196
1 Feb 2015
Bernhoff K Björck M

We have investigated iatrogenic popliteal artery injuries (PAI) during non arthroplasty knee surgery regarding mechanism of injury, treatment and outcomes, and to identify successful strategies when injury occurs.

In all, 21 iatrogenic popliteal artery injuries in 21 patients during knee surgery other than knee arthroplasty were identified from the Swedish Vascular Registry (Swedvasc) between 1987 and 2011. Prospective registry data were supplemented with case-records, including long-term follow-up. In total, 13 patients suffered PAI during elective surgery and eight during urgent surgery such as fracture fixation or tumour resection. Nine injuries were detected intra-operatively, five within 12 to 48 hours and seven > 48 hours post-operatively (two days to 23 years).

There were 19 open vascular and two endovascular surgical repairs. Two patients died within six months of surgery. One patient required amputation. Only six patients had a complete recovery of whom had the vascular injury detected at time of injury and repaired by a vascular surgeon. Patients sustaining vascular injury during elective procedures are more likely to litigate (p = 0.029).

We conclude that outcomes are poorer when there is a delay of diagnosis and treatment, and that orthopaedic surgeons should develop strategies to detect PAI early and ensure rapid access to vascular surgical support.

Cite this article: Bone Joint J 2015;97-B:192–6.


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 4 | Pages 527 - 534
1 Apr 2010
Streubel PN Gardner MJ Morshed S Collinge CA Gallagher B Ricci WM

It is unclear whether there is a limit to the amount of distal bone required to support fixation of supracondylar periprosthetic femoral fractures. This retrospective multicentre study evaluated lateral locked plating of periprosthetic supracondylar femoral fractures and compared the results according to extension of the fracture distal with the proximal border of the femoral prosthetic component.

Between 1999 and 2008, 89 patients underwent lateral locked plating of a supracondylar periprosthetic femoral fracture, of whom 61 patients with a mean age of 72 years (42 to 96) comprising 53 women, were available after a minimum follow-up of six months or until fracture healing. Patients were grouped into those with fractures located proximally (28) and those with fractures that extended distal to the proximal border of the femoral component (33).

Delayed healing and nonunion occurred respectively in five (18%) and three (11%) of more proximal fractures, and in two (6%) and five (15%) of the fractures with distal extension (p = 0.23 for delayed healing; p = 0.72 for nonunion, Fisher’s exact test). Four construct failures (14%) occurred in more proximal fractures, and three (9%) in fractures with distal extension (p = 0.51). Of the two deep infections that occurred in each group, one resolved after surgical debridement and antibiotics, and one progressed to a nonunion.

Extreme distal periprosthetic supracondylar fractures of the femur are not a contra-indication to lateral locked plating. These fractures can be managed with internal fixation, with predictable results, similar to those seen in more proximal fractures.


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 2 | Pages 217 - 221
1 Feb 2010
Hahn SB Choi YR Kang HJ Lee SH

Between 1987 and 2006 we performed a modified Thompson’s quadricepsplasty on 40 fracture-related stiff knees and followed the patients for a mean of 7.9 years (2 to 11.1). The factors affecting the final gain of movement were investigated. A total of 15 knees required lengthening of the rectus femoris. The mean flexion gain was 70.2° (42.3° to 112.5°). According to Judet’s criteria, the results were excellent in 30 knees, good in seven, and fair in three. The range of movement which was achieved intra-operatively was related to the gain of knee flexion on univariate analysis. Five patients had complications: deep infection in one, recurrent patellar dislocation in one, and rupture of the extensor mechanism in three. This modified technique gives satisfactory results. Achieving maximum knee flexion intra-operatively seems to be the most important factor in enhancing the outcome in patients with stiffness of the knee following fracture.