Can Treatment of Periprosthetic Distal Femur Fractures Result in Iatrogenic Flexion Instability in Previously Stable Total Knee Arthroplasty? A Single-Center Retrospective Review of 73 patients.

IF 1.6 3区 医学 Q3 ORTHOPEDICS
Neal Krentz, Kallie J Chen, Mark Kodsy, Akash Raju, John K Sontich
{"title":"Can Treatment of Periprosthetic Distal Femur Fractures Result in Iatrogenic Flexion Instability in Previously Stable Total Knee Arthroplasty? A Single-Center Retrospective Review of 73 patients.","authors":"Neal Krentz, Kallie J Chen, Mark Kodsy, Akash Raju, John K Sontich","doi":"10.1097/BOT.0000000000003000","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To describe outcomes in patients with periprosthetic distal femur fractures (PPDFF) who underwent retrograde intramedullary nailing (rIMN), including subsequent revision total knee arthroplasty (TKA) and subjective and/or objective evidence of flexion instability (FI). The hypothesis of this study is flexion instability can occur following rIMN in cruciate-retaining total knee arthroplasty (CR-TKA), possibly due to iatrogenic PCL damage.</p><p><strong>Methods: </strong>Design: Retrospective review.</p><p><strong>Setting: </strong>Single academic Level-I trauma center.</p><p><strong>Patient selection criteria: </strong>All patients who sustained a PPDFF, OTA/AO 33A, between 2008-2022 who were treated with a rIMN by a trauma fellowship trained orthopedic surgeon with >3 months follow-up were included. Patients with < 3 months follow-up, treated with locked plating, nail-plate combinations or whose surgery was not performed by a trauma fellowship trained orthopedic surgeon were excluded.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was rate of revision TKA for instability. Secondary outcomes included radiographic measurements (posterior tibial translation, femoral component ratio, and final coronal and sagittal alignment) and complications.</p><p><strong>Results: </strong>73 patients (61, 83.6% female) were included. Average age was 73.8 ± 12.3 years and median length of follow-up was 294 days (IQR: 156, 411 days). There were 4 (6.2%) revision TKA, performed; 3 CR-TKAs and 1 PS-TKA. All three CR-TKA knees revised were for instability. There were 16 (20.5%) complications requiring return to the OR. Median time to return to OR was 204.5 days (IQR of 135-390.25 days). The most common indication was irritable hardware (n=4, 5.5%) and nonunion (n=4, 5.5%) followed by primary instability (n=3, 4.1%). All 3 nonunions underwent revision ORIF. Five (6.8%) patients reported symptoms and 7 (9.6%) had positive physical exam findings suggestive of FI. There were 22 (30.1%) patients with radiographic posterior tibial translation.</p><p><strong>Conclusions: </strong>This retrospective review suggests that flexion instability secondary to damage of the posterior cruciate ligament is a potential complication following retrograde intramedullary of periprosthetic distal femur fractures.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Trauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BOT.0000000000003000","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0

Abstract

Objectives: To describe outcomes in patients with periprosthetic distal femur fractures (PPDFF) who underwent retrograde intramedullary nailing (rIMN), including subsequent revision total knee arthroplasty (TKA) and subjective and/or objective evidence of flexion instability (FI). The hypothesis of this study is flexion instability can occur following rIMN in cruciate-retaining total knee arthroplasty (CR-TKA), possibly due to iatrogenic PCL damage.

Methods: Design: Retrospective review.

Setting: Single academic Level-I trauma center.

Patient selection criteria: All patients who sustained a PPDFF, OTA/AO 33A, between 2008-2022 who were treated with a rIMN by a trauma fellowship trained orthopedic surgeon with >3 months follow-up were included. Patients with < 3 months follow-up, treated with locked plating, nail-plate combinations or whose surgery was not performed by a trauma fellowship trained orthopedic surgeon were excluded.

Outcome measures and comparisons: The primary outcome was rate of revision TKA for instability. Secondary outcomes included radiographic measurements (posterior tibial translation, femoral component ratio, and final coronal and sagittal alignment) and complications.

Results: 73 patients (61, 83.6% female) were included. Average age was 73.8 ± 12.3 years and median length of follow-up was 294 days (IQR: 156, 411 days). There were 4 (6.2%) revision TKA, performed; 3 CR-TKAs and 1 PS-TKA. All three CR-TKA knees revised were for instability. There were 16 (20.5%) complications requiring return to the OR. Median time to return to OR was 204.5 days (IQR of 135-390.25 days). The most common indication was irritable hardware (n=4, 5.5%) and nonunion (n=4, 5.5%) followed by primary instability (n=3, 4.1%). All 3 nonunions underwent revision ORIF. Five (6.8%) patients reported symptoms and 7 (9.6%) had positive physical exam findings suggestive of FI. There were 22 (30.1%) patients with radiographic posterior tibial translation.

Conclusions: This retrospective review suggests that flexion instability secondary to damage of the posterior cruciate ligament is a potential complication following retrograde intramedullary of periprosthetic distal femur fractures.

Level of evidence: Level III.

假体周围股骨远端骨折的治疗会导致先前稳定的全膝关节置换术的医源性屈曲不稳定吗?73例患者的单中心回顾性研究。
目的:描述行逆行髓内钉(rIMN)的股骨远端假体周围骨折(PPDFF)患者的预后,包括随后的翻修全膝关节置换术(TKA)和主观和/或客观的屈曲不稳定(FI)证据。本研究的假设是,在全膝关节置换术(CR-TKA)中,可能由于医源性PCL损伤而发生屈曲不稳定。方法:设计:回顾性分析。环境:单一学术一级创伤中心。患者选择标准:所有在2008-2022年间持续PPDFF, OTA/ ao33a的患者,由创伤奖学金培训的骨科医生进行rIMN治疗,随访10 - 3个月。随访时间< 3个月、接受锁定钢板、钉钢板联合治疗或手术不是由创伤奖学金培训的骨科医生进行的患者被排除在外。结果测量和比较:主要结果为不稳定性TKA的修正率。次要结果包括x线测量(胫骨后平移,股成分比,最终冠状和矢状排列)和并发症。结果:纳入73例患者(61例,女性83.6%)。平均年龄73.8±12.3岁,中位随访时间294天(IQR: 155,411天)。进行了4例(6.2%)修正TKA;cr - tka 3个,PS-TKA 1个。所有三个CR-TKA膝关节均因不稳定而进行了翻修。有16例(20.5%)并发症需要返回手术室。返回手术室的中位时间为204.5天(IQR为135-390.25天)。最常见的适应症是硬体易激(n=4, 5.5%)和骨不连(n=4, 5.5%),其次是原发性不稳定(n=3, 4.1%)。所有3例骨不连行ORIF翻修。5例(6.8%)患者报告了症状,7例(9.6%)的体检结果呈阳性,提示FI。22例(30.1%)患者行胫骨后移位。结论:本回顾性研究表明,后交叉韧带损伤引起的屈曲不稳定是股骨远端假体周围髓内逆行骨折的潜在并发症。证据等级:三级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of Orthopaedic Trauma
Journal of Orthopaedic Trauma 医学-运动科学
CiteScore
3.90
自引率
8.70%
发文量
396
审稿时长
3-8 weeks
期刊介绍: Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信