Risk Factors for Distal Femoral Periprosthetic Fractures after Total Knee Arthroplasty: A Systematic Review of...

The number of total knee arthroplasty (TKA) procedures performed continues to rise annually. As projections show a continued increase in these surgeries, it is important to identify patients at risk for certain complications. Distal femur periprosthetic fractures around TKA can pose notable morbidity to patients, while also imparting a marked burden on the health system. This systematic review aims to identify patient and implant characteristics that increase the risk of distal femur periprosthetic fractures. Three common literature databases were searched for "distal femur periprosthetic fracture." The resulting studies were screened for relevance and inclusion and exclusion criteria, followed by an in-depth review of various patient and implant characteristics. Thirteen studies were included in this systematic review. Despite some variation across the studies, the most common population for distal femur periprosthetic fractures was females, over the age of 70, with the American Society of Anesthesiologists (ASA) score of III. These most often occurred in a low-energy trauma or falls from standing. Additionally, when compared to native distal femur fractures, there is evidence that periprosthetic fracture patients are older, have a higher body mass index (BMI), are more commonly osteopenic or osteoporotic, and less commonly sustain these injuries as part of polytrauma. As we continue to perform increasing numbers of TKAs, identifying patients at risk for periprosthetic fractures aids in patient counseling and preventive care. This can allow patients to optimize modifiable risk factors before and after undergoing TKA in an effort to avoid sustaining periprosthetic distal femur fractures.