Abstract
Peri-prosthetic distal femoral fractures around total knee replacement is a highly complex reconstructive challenge, particularly in the presence of bone comminution and poor bone quality in elderly patients. With the incidence of peri-prosthetic fractures ranging from 0.3% to 2.5%, this is becoming a common problem. Older patients with concomitant medical issues have a very limited tolerance for prolonged immobilisation.
It is the author's practice to revise, rather that attempt to fix, peri-prosthetic fractures of the knee which are very close to the femoral or tibial implants, particularly when associated with osteoporosis and comminution. When compared to fracture fixation, distal femoral replacement has significantly shorter operative time, less blood loss, and shorter hospital stay. Patients have been shown to recover faster, have fewer complications, and left hospital sooner. The general assumption has been that the use of a distal femoral replacement prosthesis is cost prohibitive in revision total knee settings, however, initial differences in the price of the prosthesis are more than offset by a shortened hospital stay and a more rapid return to pre-fracture level of function.
