Knee arthroplasty with hardware removal: complication cascade. Is it preventable?

2020 ◽  
Vol 13 (8) ◽  
pp. e233700
Author(s):  
Gabriel Nierenberg ◽  
Alaa Abu Elasal ◽  
Eran Keltz ◽  
Doron Norman
Keyword(s):  
Distal Femur ◽  
Femur Fracture ◽  
Total Joint Replacement ◽  
Plate Fixation ◽  
Open Reduction Internal Fixation ◽  
Hardware Removal ◽  
Fixation Device ◽  
Temporary Reduction ◽  
Non Union ◽  
Total Knee

An elderly woman underwent hardware removal and total joint replacement (TJR) of her right knee. Ipsilateral total tip replacement was performed 7 years earlier, and 12 months later, a supracondylar fracture of the index femur was successfully treated by open reduction internal fixation (ORIF) of the distal femur with a locking compression plate condylar plate. Hardware removal attempt, prior to the arthroplasty, resulted in fracture of the distal femur. Total knee replacement (TKR) was commenced with temporary reduction and final stabilisation of the femur fracture with a condylar plate. Postoperatively, non-union of the femur fracture developed twice with fatigue failure of the plate fixation device in both instances. Refixation of the femur was performed on both occasions and additional bone healing augmentation measures were performed for each subsequent surgery. Femur union was achieved fourteen months after the last surgery.

scholarly journals Reverse distal femoral locking plate for subtrochanter femur fracture

2018 ◽  
Vol 27 (2) ◽  
Author(s):  
Peter Giarso ◽  
Ismail H. Dilogo
Keyword(s):  
Distal Femur ◽  
Locking Plate ◽  
Femur Fracture ◽  
Case Series ◽  
Subtrochanteric Fracture ◽  
Locking Compression Plate ◽  
Non Union ◽  
Functional Scores ◽  
The Right ◽  
Subtrochanteric Femur Fracture

In these case series, we used titanium locking compression plate-distal femur (LCP-DF) plate (Synthes) 9–11 hole using less invasive stabilization system or open reduction technique. This case series aims to determine the functional scores on reverse distal femoral locking plate for subtrochanteric femur fracture. A 34-year-old male with closed subtrochanteric fracture of the right femur (Seinsheimer 2B) with Harris hip scores (HHS) of 17, 96, and 97 obtained consecutively in 0, 6, and 12 months, respectively. A 24-year-old male with closed comminuted subtrochanteric fracture of the right femur (Seinsheimer V) with HHS of 13, 93, and 97 at 0, 6, and 12 months respectively. A 39-year-old male with non-union, left subtrochanteric femur fracture (Seinsheimer 2C) yielded HHS of 38, 73, and 77 at 0, 6, and 12 months, respectively. A 35-year-old female with close subtrochanteric fracture of the right femur (Seinsheimer IIB) yielded HHS of 23, 40, and 73 at 0, 6, and 12 months, respectively. Mean initial HHS and scores at 6 and 12 months reached 22, 75, and 86, respectively.

Decision making in the management of malunion and nonunion of intertrochanteric fractures of the hip

2019 ◽  
Vol 30 (6) ◽  
pp. 793-798 ◽  
Author(s):  
Kaushik Bhowmick ◽  
Thomas Matthai ◽  
Perumal Ramaswamy JVC Boopalan ◽  
Thilak S Jepegnanam
Keyword(s):  
Decision Making ◽  
Functional Outcomes ◽  
Intertrochanteric Fracture ◽  
Distal Femur ◽  
Femur Fracture ◽  
Intertrochanteric Fractures ◽  
Non Union ◽  
Shaft Angle ◽  
Head Shaft Angle

Aim: Intertrochanteric fractures account for almost 50% of hip fractures.Nonunion and malunion of these fractures are relatively uncommon. This study reviews the outcome of 31 cases of intertrochanteric fracture failures. An algorithm for the management of these injuries is also proposed. Methods: 19 patients with intertrochanteric malunion and 12 patients with non-union were included in this study. Treatment of these injuries was initiated according to the algorithm proposed in this study. Treatment outcomes were evaluated by assessing union, pre and postoperative shortening and HSA (head-shaft angle). Functional outcomes were assessed by the Parker mobility scale and presence or absence of pain. Results: All the patients with intertrochanteric malunion with follow-up had united. The postoperative shortening in all patients were ⩽2.5 cms. Patients having intertrochanteric nonunion with follow-up, who underwent internal fixation had united with an acceptable Parker mobility scale score, except in 1 patient who sustained an ipsilateral distal femur fracture. The average HSA correction obtained was 21° (range 3–60°). Conclusion: The algorithm proposed in this study helps streamline the treatment according to each case scenario.It helps in planning and managing patients with intertrochanteric fracture failures.

Distal Femur Tumor Megaprosthesis for Non-union of Supracondylar Femur Fracture after Failed Osteosynthesis. An Ingenious Solution.

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Bikram Kesari Kar ◽  
Mukund Madhav Ojha ◽  
Sandeep Kumar Yadav ◽  
Alok Chandra Agrawal ◽  
Sharath Kowshik
Keyword(s):  
Distal Femur ◽  
Femur Fracture ◽  
Poor Quality ◽  
Implant Failure ◽  
Geriatric Population ◽  
Early Ambulation ◽  
Non Union ◽  
Distal Femur Replacement ◽  
Knee Society Function Score

Introduction: Incidence of non-union of fracture involving the supracondylar region of femur in an elderly is increasing due to bone loss from trauma and availability of poor quality bone in geriatric population. Distal femur megaprosthesis can provide a single stage solution for resistant non-union of supracondylar femur. Case Report: We are reporting two cases of non-union of supracondylar femur with implant failure treated with distal femoral tumor megaprosthesis. We achieved excellent improvement of the Knee Society Score from 15 to 75; Knee Society Function Score from 0 to 60, good range of motion, and pain free ambulation without support at 3 months follow-up. Conclusion: Management of non-union of supracondylar femur with implant failure is challenging task. Distal femur replacement using tumor megaprosthesis is useful option for such resistant cases in achieving early ambulation and overall good functional outcome. Keywords: Non-union, distal femur fracture, megaprosthesis, supracondylar femur fracture.

scholarly journals Bilateral Periprosthetic Knee Fracture with the Right Floating Total Knee and Left Periprosthetic Patella Fracture Management Strategy: A Case Report

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lavindra Tomar ◽  
Gaurav Govil ◽  
Pawan Dhawan
Keyword(s):  
Case Report ◽  
Management Strategy ◽  
Knee Injury ◽  
Distal Femur ◽  
Femur Fracture ◽  
Left Knee ◽  
Patellar Fracture ◽  
Distal Femur Fracture ◽  
Total Knee ◽  
The Right

Introduction: Periprosthetic fractures (PPFs) in total knee replacement are an uncommon condition. The floating knee injury around total knee arthroplasty (TKA) is even rare and poses challenges in management. Incidence is increasing due to growing primary joint arthroplasties and revision procedures. We report a case of bilateral PPF with a floating total knee. Case Report: A 74-year-old female involved in a violent car accident sustained bilateral knee injuries, facial, and hand injury. In the emergency room, the initial resuscitation and trauma protocol stabilization were done and she was provisionally immobilized for her limb injuries. She presented with the right-sided floating total knee involving periprosthetic periarticular comminuted distal femur fracture and midshaft comminuted fracture tibia fibula. The patient also had left knee lower pole periprosthetic patellar fracture. The patient had a history of bilateral TKA around 2 years back. She underwent surgical management of the right floating total knee by stabilization of distal femur fracture and tibial shaft fracture fixation with locking plates. She underwent primary autologous bone grafting for both fracture sites. The left knee patellar fracture was managed conservatively in a brace. At 8 months follow-up, the patient was pain free and had consolidation of fractures. The patient walked without any walking aids. At 18 months, she had regained her pre-injury functional status. Conclusion: Each fracture in a floating total knee injury is unique and treatment should be decided based on individual analysis and the extent of soft-tissue injuries. An uncommon occurrence highlights the complex injury patterns involving PPF requiring individualized case specific management strategy. Keywords: Floating total knee, Periprosthetic knee fracture, floating knee.

scholarly journals Distal Femoral Replacement Following an Intraoperative Periprosthetic Fracture in a Patient with Prior Bone Mulch ACL Reconstruction

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Anthony Gemayel ◽  
Matthew J. Yousif ◽  
William Padget ◽  
Joseph Finch
Keyword(s):  
Acl Reconstruction ◽  
Distal Femur ◽  
Femur Fracture ◽  
Primary Total Knee Arthroplasty ◽  
Femoral Fractures ◽  
Femur Fractures ◽  
History Of ◽  
Total Knee ◽  
Primary Total Knee ◽  
Distal Femoral Replacement

Periprosthetic distal femur fractures can be treated nonoperatively, with open reduction and internal fixation or with more constrained prostheses. Distal femoral replacement is typically a last resort treatment option for comminuted periprosthetic or osteoporotic distal femoral fractures in patients with poor bone stock or resistant nonunions. We report the case of a 54-year-old female with a remote history of bone mulch ACL reconstruction who sustained an intraoperative comminuted bicondylar distal femur fracture during a primary total knee arthroplasty. This patient was treated with a distal femoral replacement and successfully returned to her preoperative function.

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