Management of Periprosthetic Femoral Fractures After Total Knee Arthroplasty Using a Distal Femoral Allograft

This study is a review and discussion of 12 consecutive patients who were revised with a distal femoral allograft for periprosthetic supracondylar fractures of the femur associated with poor bone quality by the same surgeon between 1990 and 2001. Two were lost to follow-up. The average age was 65 years, and the mean follow up was 6 years. Charts were reviewed to identify complications and graft survivorship. Functional assessment consisted of the modified Hospital for Special Surgery (HSS) knee score and the MOS 36-ITEM Short Form Health Survey. Radiographs were evaluated by 3 independent observers to determine graft union, resorption, and component loosening. The average postoperative HSS score and SF-36 were 75 and 88, respectively. Mean flexion was 100°. Nine patients achieved union and were able to fully bear weight. Three patients required more surgery as a result of postoperative complications. Radiographs showed no migration, no loos- ening, and good interface union in 9 of the 10 patients available for follow-up. We concluded that this is a viable salvage procedure for this type of injury. Key words: periprosthetic fracture, revision arthroplasty, total knee arthroplasty, allograft, su- pracondylar fracture.