Nonsurgical management of atraumatic early distal femoral periprosthetic insufficiency fracture after primary total knee arthroplasty, a report of two cases

Abstract

Periprosthetic distal femoral fractures after primary total knee arthroplasty (TKA) are considered rare; however, they pose a challenge for the treating surgeon, and the management options are mostly surgical (open reduction and internal fixation or revision surgery). We present two female patients who developed atraumatic lateral femoral condyle fractures three weeks after primary TKA; both were treated nonsurgically with acceptable outcomes and patient satisfaction. We believe that nonsurgical management of periprosthetic distal femoral fractures could be an economical solution in selected cases; it also could help maintain the distal femoral bone stock till a revision surgery is performed.

Keywords: Atraumatic fracture; Distal femur; Periprosthetic fracture; Total knee arthroplasty.

Fig. 1

Patient #1. A, Preoperative anteroposterior and lateral views of her knees bilaterally. B, immediate postoperative after bilateral TKA (aTF: anatomical tibiofemoral angle, aLDFA: anatomical lateral distal femoral angle).

Fig. 2

Follow up anteroposterior and lateral radiographs of patient #1 left TKA. A, At three weeks postoperative showing valgus deformity of the knee, lateral distal femoral condyle fracture is indicated by the yellow arrowhead. B and C, Follow up at six weeks and six months, respectively, showing maintained limb and femoral component alignment (indicated by aTF and aLDFA angles) and healing of the fracture (yellow arrowhead) (aTF: anatomical tibiofemoral angle, aLDFA: anatomical lateral distal femoral angle).

Fig. 3

Patient #2. A, Preoperative anteroposterior and lateral views of her knees bilaterally. B, An intraoperative image shows the bony defect in the medial femoral condyle and the medial tibial plateau (green arrowheads) and reconstruction using bone graft and screw (black arrowhead). C, Immediate postoperative of the right knee TKA showing accepted limb and femoral component alignment. D, Follow up at six months showing a valgus alignment of the limb and the femoral component with a healed lateral distal femoral condyle fracture (yellow arrowhead).

Fig. 4

Female patient, 71 years old, presented after 3 weeks of having right TKA with atraumatic distal femoral fracture (yellow arrowhead) and loose femoral component (a demonstrative case, not included in the report).