Management of Distal Femur Periprosthetic Fracture in Elderly Female with Distal Femur Replacement: A Case Report

Periprosthetic distal femur fractures after total knee arthroplasty are a relatively rare complication but are complex injuries with very high complication rates. Closed or open reduction with internal fixation with either locked plate or intramedullary nail is the most commonly used for treating these fractures. Success of these methods depends on the fracture pattern, the stability of implants, and the patient's bone quality which is often poor in elderly, thus resulting in high complication rates. Also the patients need to be non-weight bearing for 6 weeks which often makes elderly patients non ambulant, predisposing them to life threatening complications like deep vein thrombosis, pulmonary embolism and respiratory infections. Distal femoral replacement is another option for management of these complex fractures, which allows immediate mobilization of the patients and the results does not depend on bony union at the fracture site which is often difficult to achieve in elderly patients. Although this is a technically difficult procedure but when performed properly can be the best treatment options in elderly patients. We present here a 90 years old active female with distal femur periprosthetic fracture with complex revision total knee prosthesis in situ sustained due to trivial fall, which was managed by distal femoral replacement using limb construction system hinge prosthesis with excellent functional outcome.