Increased Utilization of Total Joint Arthroplasty for the Treatment of Distal Femoral Fractures

Primary and revision arthroplasty has emerged as an alternative option for the treatment of distal femoral fractures. The purpose of this study was to identify any trends in the management of distal femoral fractures among American Board of Orthopaedic Surgery (ABOS) Part II Candidates with regard to the utilization of open reduction and internal fixation (ORIF) versus total joint arthroplasty, and to investigate the complications associated with these two treatment strategies.

This was a retrospective cohort study of the ABOS Part II Oral Examination Case List Database which was queried between the years 2003 and 2021. The inclusion criteria consisted of adult patients who sustained a distal femoral fracture and underwent either ORIF or arthroplasty.

The proportion of distal femoral fractures treated with arthroplasty compared to ORIF increased throughout the study period by 0.28% per year (P < 0.001) overall and 1.2% per year (P < 0.001) among arthroplasty-trained surgeons. Medical and surgical complications occurred at a significantly higher rate in patients after arthroplasty as compared to ORIF (31.5 versus 20.9%, P < 0.001; 29.0 versus 17.5%, P < 0.001, respectively). Reoperation and readmission were also higher following arthroplasty (10.8 versus 6.2%, P = 0.002; and 16.5 versus 9.3%, P < 0.001, respectively).

Distal femoral fractures occurred more commonly and more of them were treated with arthroplasty. In the hands of surgeons who are early in their career, this treatment option may be associated with increased rates of revision, reoperation, and readmission.