ICJR Interviews: Role of Distal Femoral Replacement in Traumatic Fractures

    Treatment of traumatic femoral fractures with open reduction internal fixation (ORIF) in older patients can be problematic: These patients tend to have high reoperation and mortality rates.

    An alternative to ORIF is distal femoral replacement arthroplasty, which may allow patients to mobilize sooner and thus reduce complications that impede recovery, such as pressure ulcers, deep vein thrombosis, and pulmonary embolism.

    A recent study evaluated ability to weight-bear soon after surgery, knee range of motion, discharge disposition, and return to full ambulation in 56 patients who underwent distal femoral replacement arthroplasty between 2002 and 2013 for:

    • Acute, comminuted, intra-articular femur fractures
    • Periprosthetic fractures
    • Fracture non-unions in osteoporotic bone

    Follow-up was a mean of 28 months.

    Adam M. Sassoon, MD, from the University of Washington in Seattle, said the result were encouraging:

    • Overall 98% prosthesis retention (only 1 revision)
    • 85% of patients weight-bearing as tolerated right after surgery
    • 11% discharged home
    • Arc of motion an average of 98° at final follow-up
    • Only 4 patients still in a wheelchair at final follow-up
    • 9% complication rate

    Distal femoral replacement arthroplasty is a good option for this challenging patient population, the researchers said, nothing that “the complication and secondary surgery rates remained relatively low, while restoration of function was almost universally achieved, allowing patients to mobilize shortly after their injury.”

    Click the image above to hear Dr. Sassoon discuss the study, “Distal Femoral Replacement in the Treatment of Fractures: Low Complication Rates and Early Ambulation”(Paper 390), which was presented at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons in Orlando.

    Producer: Henrik B. Pedersen; Director: Michael Bugera; Post Production: Charles J. Maynard