Geriatric Distal Femur Fractures: Equivalent Long-Term Reoperation Rates Between Fixation and Primary Arthroplasty

Area of Science:

• Orthopedic Surgery
• Geriatric Trauma
• Biomaterials Science

Background:

• Geriatric distal femur fractures pose significant challenges in management.
• Open reduction internal fixation (ORIF) and primary arthroplasty are common treatment options.
• Understanding long-term outcomes is crucial for optimizing patient care.

Purpose of the Study:

• To determine the rate of conversion to arthroplasty following ORIF in geriatric distal femur fractures.
• To compare the 10-year reoperation rates between ORIF and primary arthroplasty for these fractures.

Main Methods:

• Retrospective cohort study utilizing the California OSHPD database (2000-2017).
• Propensity-matched analysis comparing ORIF, total knee arthroplasty (TKA), and distal femur replacement (DFR).
• Focus on reoperation as the primary outcome measure.

Main Results:

• A low 10-year cumulative incidence of conversion to arthroplasty after ORIF (3.5%), with younger age and female sex as risk factors.
• No significant difference in 10-year reoperation-free survival between ORIF and primary arthroplasty (94.5% vs. 96.2%).
• Primary arthroplasty was associated with higher rates of acute wound or joint infection within 90 days.

Conclusions:

• The rate of conversion to arthroplasty after ORIF for geriatric distal femur fractures is low.
• Long-term reoperation rates are comparable between ORIF and primary arthroplasty.
• Primary arthroplasty increases the risk of acute wound or joint infections.