Comparing Outcomes of Tumor Prosthesis Revision and Locking Plate Fixation in Supracondylar Femoral Periprosthetic Fractures

BACKGROUND: Periprosthetic fractures around a total knee replacement (TKR) can be complex and difficult to manage, requiring the surgical expertise of the trauma and arthroplasty surgeon. There are a number of treatment modalities available, each with their own merits and limitations. As data on tumor prosthesis revision in periprosthetic fractures is sparse, this study aims to evaluate the results of revision using a tumor prosthesis and compare them with those of fixation using a locking plate in periprosthetic fractures after TKR. METHODS: This is a retrospective study of 15 patients who underwent either tumor prosthesis revision (n = 7) or locking plate fixation (n = 8) for supracondylar femoral periprosthetic fractures in our hospital from 2009 and 2014. The mean follow-up time for these patients was 44 months. This study's main outcome measures were pain relief, return to premorbid ambulatory function, and complications. RESULTS: The revision and fixation groups saw five versus three patients achieve pain relief (71.4% vs. 37.5%, p = 0.315), and two versus four patients return to their premorbid ambulatory function (28.6% vs. 50%, p = 0.608) at the follow-up, respectively. The mean time to weight-bearing in the revision group and fixation group was 2.9 days and 18.9 weeks, respectively (p = 0.001). There were eight complications seen in the revision group with none requiring reoperation; there were five complications seen in the fixation group, and two required reoperation. CONCLUSIONS: The results of revision TKR using a tumor prosthesis were comparable to those of fixation using a locking plate in periprosthetic fractures after TKR. Tumor prosthesis revision may be considered as a viable alternative to locking plate fixation when indicated.