Title : Outcomes of periprosthetic distal femur fractures managed surgically with fixation or revision to Distal Femoral Replacement (DFR)
Abstract:
Introduction: With an ageing population and increasing arthroplasty prevalence, periprosthetic distal femur fractures are rising. Surgical management includes open reduction internal fixation (ORIF) or revision to Distal Femoral Replacement (DFR). This study reviews outcomes following these approaches.
Methodology: A retrospective review of 67 patients (mean age: 77.8, range: 44-95) treated for periprosthetic distal femur fractures with ORIF (n=30) or DFR (n=37) was conducted at a single centre (2012-2022). Data included demographics, time to surgery, mortality, complications and patient-reported outcomes.
Results: 1-year mortality was 16% (55% DFR vs. 45% ORIF). Relative risk of death for DFR vs ORIF was 0.97 (p=0.96). Average time to death was longer for DFR (1212 days, range: 5-3825) vs ORIF (986 days, range: 41-2169). Median EQ5D score was 57.5 (range: 0-95), with DFR scoring lower (55, range: 0-90) vs ORIF (75, range: 50-95). Scores reflected moderate-to-severe issues with mobility and daily activities. Median Oxford Knee Score was 11.5 (range: 0-43), this was lower in DFR (9, range 0-39) vs ORIF (25, range: 13-43). DFR patients had a longer time to surgery (6.8 vs 2.6 days; p=<0.001) but similar hospital stays (23 vs 21 days; p=0.347). Complications included infections in 9 (13%) patients (16% DFR vs 10% ORIF). All patients achieved full weight-bearing postoperatively.
Conclusion: ORIF and DFR are viable options for managing periprosthetic distal femur fractures. Mortality risk at 1-year, was similar, however DFR may be associated with higher complication rates and delayed surgery. Careful patient selection and further research are required to optimise treatment strategies.
