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Distal Femoral Replacement and Periprosthetic Joint Infection After Non-Oncological Reconstruction: A Retrospective
Kamolsak Sukhonthamarn1, John T Strony2, Urvi J Patel2
1Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
The Journal of Arthroplasty
|September 14, 2021
Summary
Distal femoral replacement (DFR) is a valuable option for knee bone loss, but carries a high risk of complications. Patients with prior periprosthetic joint infection (PJI) face the lowest survivorship and increased PJI risk.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Reconstructive Surgery
Background:
- Distal femoral replacement (DFR) is crucial for managing extensive bone loss around the knee.
- Indications include aseptic loosening, periprosthetic joint infection (PJI), and distal femoral fractures.
- Existing studies show variable long-term survivorship outcomes for DFR.
Purpose of the Study:
- To investigate the outcomes of distal femoral replacement (DFR).
- To analyze DFR performance in patients with aseptic failures, fractures, and PJI.
- To assess implant survivorship and risk factors for revision.
Main Methods:
- Retrospective review of 182 patients undergoing DFR (2002-2018).
- Data collection included indication, complications, reoperations, revisions, and follow-up.
- Kaplan-Meier curves and Cox regression were used to analyze survivorship and revision risk.
Main Results:
- High overall complication rate (36%), with PJI being the most frequent (17%).
- Reoperation rate was 29.7%, and revision rate was 13.7%, with PJI as the primary cause for re-revision (7.1%).
- Ten-year revision-free survivorship was 73.4%; patients with prior PJI had significantly lower survivorship and higher PJI risk.
Conclusions:
- DFR is a vital reconstructive procedure for massive knee bone loss.
- However, DFR patients face substantial risks of complications, reoperations, and implant failure.
- Prior PJI is a significant negative prognostic factor for DFR outcomes.
