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Multicenter Study
. 2025 Dec 1;39(12):644-652.
doi: 10.1097/BOT.0000000000003059.

Outcomes After Distal Femur Replacement for Fracture: A Multi-Institutional Retrospective Review

David C Landy  1 , Jeffrey A Foster  2 , Wyatt G S Southall  3 , Austin T Gregg  4 , Stephen T Duncan  3 , Michael T Archdeacon  5 , William T Obremskey  6 , Joshua M Lawrenz  6 , Christopher Lee  7 , Michael S Sridhar  8 , Arun Aneja  4 ; “DFR Research Group”
Collaborators, Affiliations
Multicenter Study

Outcomes After Distal Femur Replacement for Fracture: A Multi-Institutional Retrospective Review

David C Landy et al. J Orthop Trauma. .

Abstract

Objectives: To estimate representative outcomes of patients who underwent distal femur replacement (DFR) for distal femur fractures (DFFs).

Design: Retrospective Cohort Study.

Setting: Twelve academic trauma centers in the United States.

Patient selection criteria: Adult patients who underwent DFR for native or periprosthetic DFF (OTA/AO 33A1.1-33C3.3) from 2010 to 2022 were included. Patients who underwent DFR for infectious, oncologic, and/or other indications besides fracture fixation were excluded.

Outcome measures and comparisons: The primary outcome was periprosthetic joint infection (PJI). Secondary outcomes included reoperation, 1-year mortality, and function. Outcomes were estimated using proportions and Kaplan-Meier curves with 95% confidence intervals (CI) and stratified by periprosthetic fracture with Fisher exact testing.

Results: One hundred seventy-three patients were included, with 130 (75%) having a periprosthetic DFF. The median age was 77 [interquartile range, 70-84] and the median final follow-up was 6 months [interquartile range, 2-14], with 146 women (84%) and several medical comorbidities (63% American Society of Anesthesiologists class III and 24% American Society of Anesthesiologists class IV). The rate of PJI was 5.8% (95% CI, 3.1%-10.5%). PJI was 2.3% for native compared with 6.9% for periprosthetic DFF ( P = 0.45). The reoperation rate was 16.6% (95% CI, 11.7%-23.0%), and the 1-year mortality was 27% (95% CI, 20%-35%). Fifty-five percent of patients returned to their baseline function (95% CI, 46.9%-62.1%).

Conclusions: DFR for native and periprosthetic DFF was associated with a PJI rate of 5.8%. The 1-year mortality rate was 27.0%, and the reoperation rate was 16.6%. Fifty-five percent of patients returned to their baseline function. DFR can be considered as an option in cases of complex native and periprosthetic DFF, although surgeons should continue to counsel patients on the considerable risks associated with DFR when assessing treatment options.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Keywords: distal femur fracture; distal femur replacement; mortality; periprosthetic fracture; periprosthetic joint infection; reoperation.

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Conflict of interest statement

D. C. Landy is on the editorial or governing board for American Journal of Sports Medicine and is a paid presenter or speaker for Smith & Nephew. S. T. Duncan is a paid consultant for Bone Support, Heron, Heraeus, OrthAlign, Smith & Nephew, and Zimmer; receives research support from Bone Support, Medtronic, Smith & Nephew, and Zimmer; is on the editorial or governing board for Journal of Arthroplasty, Journal of Knee Surgery, Journal of the American Academy of Orthopaedic Surgeons; is a board or committee member for Kentcuky Orthopaedic Society; has stock or stock options in MiCare and Rom3; and receives IP royalties from Smith & Nephew. M. T. Archdeacon reports other professional activities from Stryker. W. T. Obremskey reports other professional activities from Orthopedic Trauma Association. J. M. Lawrenz is a board or committee member for Musculoskeletal Tumor Society. C. Lee is a paid presenter or speaker for DePuy, Johnson & Johnson Company; reports IP royalties from Globus Medical; is a paid consultant for Globus Medical, Smith & Nephew, Stryker, and Synthes; and is on the board or committee member for Orthopaedic Trauma Association. A. Aneja reports honoraria from the Arbeitsgemeinschaft fur Osteosynthesefragen Foundation and research support from the Orthopaedic Trauma Association, American Orthopaedic Foot and Ankle Society, and United States Department of Defense. A. Aneja is a board or committee member for American Academy of Orthopaedic Surgeons and Orthopaedic Trauma Association. The remaining authors report no conflict of interest.

References

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