Introduction

Periprosthetic fractures around TKA are becoming more frequent and challenging due to the high rate of associated complications. This is mostly due to the progressive increase in life expectancy, the incidence of bone-debilitating diseases, as well as the high percentage of the population with TKA. Treatment options include conservative, open reduction and internal fixation with plate or nail, and revision atroplasty.
Objectives
The aim is to present our series in the treatment of this type of fractures, as well as the most frequent complications, and their subsequent resolution.

Material And Methods

Retrospective review of the series in our Hospital. The following aspects were recorded; primary TKA type, interval until fracture occurred, fracture type based on Lewis-Rorabeck and Su's classification, type of fixation performed, and revision surgery and subsequent complications.

Results

40 cases of periprosthetic distal femur fractures after TKA were recorded Between 2005 and 2020. 37 (92%) women and 3(8%) men, with mean age 82 (61-99). According to Lewis-Rorabeck and Su's classification, type II was the most frequent (68% and 49% respectively). The great majority were treated with osteosynthesis with nail/plate (60%). 7 out of the 29 patients (17,5%) treated with ORIF underwent revision surgery to tumoral prosthesis due to septic pseudoarthrosis. Of the group treated with prostheses at entry (11), only 1 (2.5%) suffered a case of bad evolution, which ended up with arthrodesis, and another suffered femoral malrotation, which was successfully corrected after 10 days. 65% did not receive cement associated with the definitive treatment, and 73% did not receive a bone graft. Likewise, the evolution during hospitalization was faster in the latter group of patients, being discharged by walking with crutches from the beginning.
Of the 23 patients with fracture type II according to Lewis-Rorabeck, 20 (87%) were treated with osteosynthesis, and only 2 treated initially with prosthesis. In the same way, those with fracture type III (12), the great majority 9 (75%) were treated initially with prosthesis. Similar results were found using the SU classification.
On the other hand, it was observed that the longer the time that elapsed from primary surgery until the fracture occurred, the greater the complexity of the fracture.

Conclusion

One of the aspects stressed in the literature is the difficulty with which these fractures achieve a good stable fixation due to the poor quality of the bone. The possibility of implanting more or less complex revision prostheses can be considered, even when there is, apparently, a well anchored implant without osteolysis in the imaging tests. In our experience, we have observed that there is a greater incidence of fractures with loosened implants and therefore this type of patient will benefit from a single surgery by means of revision arthroplasty.
We believe it is appropriate to conclude that in those older patients with osteoporosis, a fracture very distal to the primary PTR shield, and little distal bone for the plate screws, even with the integrated implant, it is convenient to perform a ONE SHOT SURGERY by means of the arthroplasty.