Total knee replacement including a modular distal femoral component in elderly patients with acute fracture or nonunion.

Distal femoral fracture or nonunion in elderly patients with osteopenic bone and coexisting gonarthrosis poses a difficult treatment challenge. Open reduction and internal fixation with or without the use of bone cement may not provide sufficient stabilization, requires a prolonged period of weightbearing restrictions, and does not address preexisting knee arthrosis. We report five patients, three with distal femoral nonunion, two with acute distal femoral fracture, and all with concomitant gonarthrosis treated with total knee replacement including a modular distal femoral component [distal femoral replacement (DFR)]. In this group of patients, modular DFR provided immediate pain relief and allowed early weightbearing and aggressive rehabilitation. We recommend this treatment modality in selected osteopenic elderly patients with difficult distal femoral reconstructive problems and coexisting gonarthrosis.