Injury · 2026
Distal femoral replacement carries higher infection and revision risk than ORIF for distal femoral periprosthetic fractures in elderly patients.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Boutany Magd, Elnaggar Alqasim, Saad Jawad, Abdelnour David, Wajahath Muaaz, Vyskocil Joseph, Suhrawardy Ameen, Vaidya Rahul
Аннотация
INTRODUCTION: Distal femoral periprosthetic fractures following TKA are increasingly common in elderly patients. Surgical management most commonly involves either open reduction and internal fixation (ORIF) or distal femoral replacement (DFR); however, comparative data regarding short-term and long-term complications remain limited. As such, this study compared complications between ORIF and DFR in elderly patients with distal femoral periprosthetic fractures following TKA.
METHODS: A retrospective cohort study was performed using the TriNetX Research Network. Patients aged ≥65 years with distal femoral periprosthetic fractures were identified and categorized by operative treatment. Propensity score matching was performed to balance cohorts. Short-term complications were assessed at 90 days, and long-term complications were evaluated at 1 and 5 years. Complications were compared using risk differences and risk ratios with 95% confidence intervals, and Kaplan-Meier survival methods.
RESULTS: After matching, 698 patients remained in each cohort. Most 90-day complications were similar between groups. However, DFR was associated with higher rates of wound disruption (7.6% vs 2.7%, RR 2.79 [95% CI 1.67-4.66], p<0.001) and transfusion (17.5% vs 13.0%, RR 1.34 [1.04-1.72], p=0.021). At 5-year follow-up, DFR demonstrated higher risks of periprosthetic joint infection (22.5% vs 5.3%, RR 4.24 [3.01-5.98], p<0.001), revision TKA (15.5% vs 3.3%, RR 4.70 [3.03-7.27], p<0.001), and subsequent knee procedures (24.4% vs 14.9%, RR 1.64 [1.31-2.04], p<0.001). Conversely, repeat periprosthetic fractures were more frequent following ORIF (55.3% vs 44.8%), with DFR demonstrating a lower relative risk (RR 0.81 [0.73-0.90], p<0.001). Similarly, additional fixation procedures occurred more often after ORIF (4.9% vs 1.6%), while DFR was associated with a reduced relative risk (RR 0.32 [0.17-0.63], p<0.001). Mortality was similar between approaches at both 30 days (2.2% vs 2.2%, RR 1.00 [0.48-2.08], p=1.00) and 5 years (16.0% vs 15.4%, RR 1.04 [0.81-1.33], p=0.764).
CONCLUSION: Short-term systemic complication rates were comparable between approaches, although DFR was associated with greater perioperative morbidity. Over longer follow-up, DFR demonstrated higher implant-related infection and revision risks, whereas ORIF carried higher risks of refracture and secondary fixation. These findings highlight a tradeoff between the immediate stability and mobilization of DFR and longer-term implant-related complications, supporting individualized treatment selection based on patient-specific risk factors.
METHODS: A retrospective cohort study was performed using the TriNetX Research Network. Patients aged ≥65 years with distal femoral periprosthetic fractures were identified and categorized by operative treatment. Propensity score matching was performed to balance cohorts. Short-term complications were assessed at 90 days, and long-term complications were evaluated at 1 and 5 years. Complications were compared using risk differences and risk ratios with 95% confidence intervals, and Kaplan-Meier survival methods.
RESULTS: After matching, 698 patients remained in each cohort. Most 90-day complications were similar between groups. However, DFR was associated with higher rates of wound disruption (7.6% vs 2.7%, RR 2.79 [95% CI 1.67-4.66], p<0.001) and transfusion (17.5% vs 13.0%, RR 1.34 [1.04-1.72], p=0.021). At 5-year follow-up, DFR demonstrated higher risks of periprosthetic joint infection (22.5% vs 5.3%, RR 4.24 [3.01-5.98], p<0.001), revision TKA (15.5% vs 3.3%, RR 4.70 [3.03-7.27], p<0.001), and subsequent knee procedures (24.4% vs 14.9%, RR 1.64 [1.31-2.04], p<0.001). Conversely, repeat periprosthetic fractures were more frequent following ORIF (55.3% vs 44.8%), with DFR demonstrating a lower relative risk (RR 0.81 [0.73-0.90], p<0.001). Similarly, additional fixation procedures occurred more often after ORIF (4.9% vs 1.6%), while DFR was associated with a reduced relative risk (RR 0.32 [0.17-0.63], p<0.001). Mortality was similar between approaches at both 30 days (2.2% vs 2.2%, RR 1.00 [0.48-2.08], p=1.00) and 5 years (16.0% vs 15.4%, RR 1.04 [0.81-1.33], p=0.764).
CONCLUSION: Short-term systemic complication rates were comparable between approaches, although DFR was associated with greater perioperative morbidity. Over longer follow-up, DFR demonstrated higher implant-related infection and revision risks, whereas ORIF carried higher risks of refracture and secondary fixation. These findings highlight a tradeoff between the immediate stability and mobilization of DFR and longer-term implant-related complications, supporting individualized treatment selection based on patient-specific risk factors.