Revision Distal Femoral Replacements Have a More-Than-40% Failure and Reoperation Rate

Distal femoral replacement (DFR) is a complex reconstruction option for patients who have substantial bone loss, often following multiple failed revision total knee arthroplasties. However, 5-year survivorship after DFR is only 70 to 85%, and there is a paucity of literature evaluating outcomes following revision distal femoral replacements (rDFRs). Therefore, this study aimed to analyze the survivorship and outcomes of rDFR.

This retrospective study identified a consecutive cohort of all patients who underwent DFR at a single institution between 2004 and 2022. Among this population, patients who failed DFR and underwent rDFR were analyzed. All patients had a minimum 2-year follow-up from rDFR. There were 54 patients who underwent rDFR at a mean time of 19.7 months after their index DFR. The primary outcome was reoperation after rDFR. Secondary outcomes included the mechanism of failure, complications, readmission, amputation, and mortality.

Among the 54 patients who underwent rDFR, 22 patients (41%) failed rDFR and had a reoperation. At the most recent follow-up, patients who had rDFRs had a 46% 90-day readmission rate, 9% amputation rate, and 11% mortality rate. The 5-year reoperation-free survivorship after rDFR was 61%. Periprosthetic joint infection was the most common indication for rDFR (43%) and the most common reason for failure of rDFR (59%). Women were significantly associated with the failure of rDFR (P = 0.029).

The outcomes following rDFR are poor, with high reoperation rates, early postoperative failure, complications, and amputation. These outcomes and risks should be shared with patients when discussing limb salvage options before these operations.