Clinical Outcomes Following Distal Femur Replacement for Periprosthetic Distal Femur Fractures: A Systematic Review...

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Reconstructive Surgery

Background:

• Periprosthetic distal femur fractures (PDFFs) present complex management challenges due to poor bone quality and limited bone stock.
• Traditional fixation methods for PDFFs are often prone to failure.
• Distal femoral replacement (DFR) is an emerging treatment option for these challenging fractures.

Purpose of the Study:

• To systematically review the existing literature on distal femoral replacement (DFR) for periprosthetic distal femur fractures (PDFFs).
• To summarize the clinical outcomes, complications, and mortality associated with DFR in treating PDFFs.

Main Methods:

• A systematic literature search was conducted across PubMed, MEDLINE (EBSCO), and Cochrane Central Database.
• Articles reporting on 5 or more knees treated with DFR for PDFFs were included.
• Random effects meta-analysis was employed to estimate outcomes, and publication bias was assessed.

Main Results:

• Fifteen studies, including 14 retrospective reports on 352 knees, were analyzed.
• Post-DFR, 87% of patients achieved ambulation, with a mean Knee Society Score of 80.
• The periprosthetic joint infection rate was 4.3%, and the 1-year mortality rate was 10%.

Conclusions:

• Distal femoral replacement (DFR) demonstrates high functional outcomes for periprosthetic distal femur fractures (PDFFs) with a seemingly modest risk of complications.
• Reported infection and mortality rates may represent lower-bound estimates due to potential publication bias and patient loss to follow-up.
• Further research into the long-term efficacy and safety of DFR for PDFFs is warranted, although short-term results are encouraging.