Dual Plating for Periprosthetic Distal Femoral Fractures Following Total Knee Arthroplasty: A Systematic Review

The demand for total knee arthroplasty (TKA) is projected to double over the next decade; consequently, the incidence of periprosthetic fractures associated with TKA is also rising. One of the most frequently used constructs is a single lateral locking plate, chosen for its ease of application and familiarity. However, single lateral plating has been associated with a high incidence of nonunion, complications, and revision. Augmenting the lateral plate construct with a medial plate decreases the likelihood of failure, offering stronger fixation for low periprosthetic fractures. The aim of this study was to review the existing literature on dual plating for distal femoral fractures in patients undergoing TKA.

A systematic review of scientific articles listed in medical databases (PubMed, Scopus) from September 2014 to December 2024 was carried out, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data collected included author name, study design, patient demographic characteristics, clinical results, radiological outcomes, postoperative complications or adverse events, length of follow-up, cause and rate of failure, and time to full weight-bearing.

Of the 895 articles identified, 690 did not meet the eligibility criteria and were excluded. Thirty-eight articles underwent full-text review, and six studies were included in the final analysis. Five were retrospective studies and one was a case series. The total number of patients was 137 (16 male, 121 female), with study sizes ranging from 15 to 38 patients. The double plate technique was most frequently applied in Su type 3 fractures. Dual plating resulted in positive clinical outcomes and a satisfactory union rate in comminuted distal femoral fractures: bone callus formation was observed in 135 of 137 patients (98.5%). Immediate postoperative weight-bearing was permitted in three of the six studies, while in two others it was delayed until 10-12 or 23 weeks. Osteosynthesis failure occurred in only two cases (2%). Secondary intervention was required in nine cases (6.5%), and complications were reported in 24 patients (17.6%), primarily due to infection or intolerance of plate screws.

Dual plating is a reliable approach for managing periprosthetic fractures associated with TKA, even in low fractures and when medial or metaphyseal comminution is present, offering high rates of anatomic reduction and low rates of reoperation and complications.