The Incidence and Further Outcome of Periprosthetic Supracondylar Femoral Fractures Post Total Knee Arthroplasty in India

Background: Periprosthetic supracondylar femoral fractures following total knee arthroplasty (TKA) are infrequent, but is a nightmarish complication. The purpose of this study was to evaluate the incidence and outcomes of periprosthetic supracondylar femoral fractures following TKA using nonoperative as well as open reduction and internal fixation (ORIF) techniques. Materials and Methods: Between August 2014 and August 2019, we followed 3920 operated patients of total knee arthroplasty (TKA) conducted at Patan Janta Hospital& Research Foundation and identified a total of 23 patients with periprosthetic supracondylar fractures. A retrospective analysis of the records of these patients was conducted. Details regarding pre fracture status, treatment offered and the present status were recorded and analyzed. Time from index arthroplasty to periprosthetic fracture ranged from five days to six years. There were 17 men and 6 women and the average age was 68.26 years (range 52-83 years). Of the 23 patients, 20 patients were managed with operative methods, whereas only three patients with relatively undisplaced fractures were treated nonoperatively. Results: The total incidence of periprosthetic fractures in operated cases of TKA was 0.58 %. Three patients had infection after surgery. As per radiological assessment, two of three conservatively treated cases had malunion, whereas among 20 cases treated operatively, 16 had primary union with one malunion. Two patients had union after bone grafting, whereas two had nonunion. The average reduction in the knee score after fracture was 20.53 %. Twenty one patients were able to achieve limited but independent activity. Conclusions: Desirable results for periprosthetic fractures can be obtained if proper and timely intervention is done. However, short duration of followup and small number of patients were the major limiting factors of this study