Similar outcomes of locking compression plating and retrograde intramedullary nailing for periprosthetic supracondylar femoral fractures following total knee arthroplasty: a meta-analysis

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 25; no. 9; pp. 2921 - 2928
• Main Authors: Shin, Young-Soo, Kim, Hyun-Jung, Lee, Dae-Hee
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2017; John Wiley & Sons, Inc
• Subjects: Arthroplasty (knee); Arthroplasty, Replacement, Knee - adverse effects; Biomedical materials; Bone Plates; Clinical outcomes; Compression; Femoral Fractures - etiology; Femoral Fractures - surgery; Femur; Fixation; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Intramedullary; Fracture Healing; Fractures; Fractures, Ununited - etiology; Humans; Intramedullary nails; Joint surgery; Knee; Locking; Medical personnel; Medicine; Medicine & Public Health; Meta-analysis; Nails; Nonunion; Operative Time; Orthopedics; Patients; Periprosthetic Fractures - etiology; Periprosthetic Fractures - surgery; Reoperation; Statistical analysis; Surgery; Surgical implants; Locking plate; Intramedullary nail; Total knee arthroplasty; Distal femur; Periprosthetic fracture
• ISSN: 0942-2056; 1433-7347; 1433-7347
• DOI: 10.1007/s00167-016-4050-0

Purpose This meta-analysis was designed to compare clinical outcomes, including knee scale score and nonunion rate, of patients with periprosthetic supracondylar fractures of the distal femur after total knee arthroplasty (TKA) who were treated using locking compression plates and retrograde intramedullary nails. Methods Studies were included in this meta-analysis if they compared clinical outcomes, including operation time, Knee Society Score (KSS), time to union, nonunion rate, and revision rate due to nonunion, in patients who underwent locking compression plate or retrograde intramedullary nail for periprosthetic distal femur fractures following TKA. Results Eight studies were included in this meta-analysis. Mean operation time was 11 min shorter (95 % CI −9.56 to 31.33 min; n.s.) and KSS one point higher (95 % CI −8.88 to 11.10; n.s.) with retrograde intramedullary nail than with locking compression plate, but these differences were not statistically significant. The two groups were also similar in mean time to union (0.46 weeks 95 % CI −1.17 to 2.08 weeks; n.s.), the proportion of subjects with nonunion (OR 0.83, 95 % CI 0.26–2.60; n.s.) and the proportion that underwent revision surgery (OR 0.88, 95 % CI 0.32–2.40; n.s.). Conclusions Clinical outcomes, including nonunion and revision rates, were similar in patients who underwent locking compression plate and retrograde intramedullary nail fixation for periprosthetic supracondylar femoral fracture following TKA. Orthopaedic surgeons must train to master both the retrograde intramedullary nail and locking compression plate techniques because both approaches can be considered for periprosthetic distal femur fracture after TKA as they have similar clinicoradiologic outcomes. Level of evidence II.