Related Experiment Video
Updated: Jul 22, 2026
Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position
Published on: August 17, 2017
Prior Femoral Canal Instrumentation Is a Major Risk Factor for Fixation Failure After Distal Femoral Replacement
Andrew J Hughes1, Colin C Neitzke2, Jeffrey A O'Donnell2
1Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York; Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, New York, New York; National Orthopaedic Hospital Cappagh, Dublin, Ireland.
Background:
Distal femoral replacement (DFR) is a salvage option for massive femoral bone loss and is often performed in revision total knee arthroplasty (rTKA) that have undergone multiple prior procedures. This study aimed to report on a large cohort of DFRs performed at a tertiary referral institution regarding survivorship and risk factors for aseptic loosening, specifically the impact of a previously instrumented femoral canal.
Methods:
Between 2016 and 2021, 105 patients undergoing rTKA to DFR with a minimum 2-year follow-up were identified. Kaplan-Meier estimates assessed survivorship free from all-cause reoperation, all-cause revision, and revision for aseptic loosening. Logistic regressions were conducted to assess potential risk factors for radiographic loosening and the need for revision.
Results:
Prior femoral canal instrumentation was identified in 59% of cases, and 54% had undergone multiple prior procedures. The 2-year survivorship free from revision for aseptic loosening was 93%. The 2-year survivorship free from all-cause reoperation was 87% for native canals and 59% for previously instrumented canals (P = 0.008). The 2-year survivorship free from all-cause revision was 100 and 81%, respectively (P = 0.014). Regression analysis found re-rTKA (odds ratio [OR] = 18.3, P = 0.006), prior femoral canal instrumentation (OR = 14.6, P = 0.01), and prior femoral canal cementation (OR = 8.2, P = 0.007) to be risk factors for aseptic loosening.
Conclusions:
A DFR for rTKA had high 2-year survivorship free from revision for aseptic loosening (93%). Regression analyses revealed multiple risk factors for aseptic femoral component loosening with a previously instrumented femoral canal, resulting in a 2.8-times higher rate of reoperation, a 10.5-times higher rate of all-cause revision, and an 11-times higher rate of aseptic loosening. Future research on fixation strategies in sclerotic, previously instrumented femoral canals should be prioritized to reduce the risk of fixation failure in this high-risk cohort.
More Related Videos
08:20A Reliable and Reproducible Critical-Sized Segmental Femoral Defect Model in Rats Stabilized with a Custom External Fixator
Published on: March 24, 2019
05:34A Mini-Invasive Internal Fixation Technique for Studying Immobilization-Induced Knee Flexion Contracture in Rats
Published on: May 20, 2019
