Periprosthetic Fractures Around Total Knee Arthroplasty with a Stable Femoral Component

  • John S. Hwang
  • Cory Collinge


This chapter discusses principles and controversies surrounding the treatment of periprosthetic fractures above a knee replacement. Evaluation and treatment decisions, as well as surgical tips and tricks, are discussed.


Periprosthetic fracture Osteoporosis Knee arthroplasty Distal femur Supracondylar femur Supracondylar Periprosthetic Knee 


  1. 1.
    Streubel PN. Mortality after periprosthetic femur fractures. J Knee Surg. 2013;26(1):27–30.CrossRefGoogle Scholar
  2. 2.
    Streubel PN, Ricci WM, Wong A, Gardner MJ. Mortality after distal femur fractures in elderly patients. Clin Orthop Relat Res. 2011;469(4):1188–96.CrossRefGoogle Scholar
  3. 3.
    Rorabeck CH, Taylor JW. Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin North Am. 1999;30(2):209–14.CrossRefGoogle Scholar
  4. 4.
    Kim KI, Egol KA, Hozack WJ, Parvizi J. Periprosthetic fractures after total knee arthroplasties. Clin Orthop Relat Res. 2006;446:167–75.CrossRefGoogle Scholar
  5. 5.
    Su ET, DeWal H, Di Cesare PE. Periprosthetic femoral fractures above total knee replacements. J Am Acad Orthop Surg. 2004;12(1):12–20.CrossRefGoogle Scholar
  6. 6.
    Culp RW, Schmidt RG, Hanks G, Mak A, Esterhai JL Jr, Heppenstall RB. Supracondylar fracture of the femur following prosthetic knee arthroplasty. Clin Orthop Relat Res. 1987;222:212–22.Google Scholar
  7. 7.
    Merkel KD, Johnson EW Jr. Supracondylar fracture of the femur after total knee arthroplasty. J Bone Joint Surg Am. 1986;68(1):29–43.CrossRefGoogle Scholar
  8. 8.
    Streubel PN, Gardner MJ, Morshed S, Collinge CA, Gallagher B, Ricci WM. Are extreme distal periprosthetic supracondylar fractures of the femur too distal to fix using a lateral locked plate? J Bone Joint Surg Br. 2010;92(4):527–34.CrossRefGoogle Scholar
  9. 9.
    Taljanovic MS, Hunter TB, Miller MD, Sheppard JE. Gallery of medical devices: part 1: orthopedic devices for the extremities and pelvis. Radiographics. 2005;25(3):859–70.CrossRefGoogle Scholar
  10. 10.
    Healy WL, Siliski JM, Incavo SJ. Operative treatment of distal femoral fractures proximal to total knee replacements. J Bone Joint Surg Am. 1993;75(1):27–34.CrossRefGoogle Scholar
  11. 11.
    Davison BL. Varus collapse of comminuted distal femur fractures after open reduction and internal fixation with a lateral condylar buttress plate. Am J Orthop. 2003;32(1):27–30.PubMedGoogle Scholar
  12. 12.
    Figgie MP, Goldberg VM, Figgie HE 3rd, Sobel M. The results of treatment of supracondylar fracture above total knee arthroplasty. J Arthroplast. 1990;5(3):267–76.CrossRefGoogle Scholar
  13. 13.
    Ricci WM, Loftus T, Cox C, Borrelli J. Locked plates combined with minimally invasive insertion technique for the treatment of periprosthetic supracondylar femur fractures above a total knee arthroplasty. J Orthop Trauma. 2006;20(3):190–6.CrossRefGoogle Scholar
  14. 14.
    Norrish AR, Jibri ZA, Hopgood P. The LISS plate treatment of supracondylar fractures above a total knee replacement: a case-control study. Acta Orthop Belg. 2009;75(5):642–8.PubMedGoogle Scholar
  15. 15.
    Kolb W, Guhlmann H, Windisch C, Marx F, Koller H, Kolb K. Fixation of periprosthetic femur fractures above total knee arthroplasty with the less invasive stabilization system: a midterm follow-up study. J Trauma. 2010;69(3):670–6.CrossRefGoogle Scholar
  16. 16.
    Hoffmann MF, Jones CB, Sietsema DL, Koenig SJ, Tornetta P 3rd. Outcome of periprosthetic distal femoral fractures following knee arthroplasty. Injury. 2012;43(7):1084–9.CrossRefGoogle Scholar
  17. 17.
    Kregor PJ, Hughes JL, Cole PA. Fixation of distal femoral fractures above total knee arthroplasty utilizing the Less Invasive Stabilization System (L.I.S.S.). Injury. 2001;32(Suppl 3):SC64–75.CrossRefGoogle Scholar
  18. 18.
    Raab GE, Davis CM 3rd. Early healing with locked condylar plating of periprosthetic fractures around the knee. J Arthroplast. 2005;20(8):984–9.CrossRefGoogle Scholar
  19. 19.
    Kolb W, Guhlmann H, Windisch C, Marx F, Kolb K, Koller H. Fixation of distal femoral fractures with the less invasive stabilization system: a minimally invasive treatment with locked fixed-angle screws. J Trauma. 2008;65(6):1425–34.CrossRefGoogle Scholar
  20. 20.
    Weight M, Collinge C. Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur (AO/OTA types A2, A3, C2, and C3). J Orthop Trauma. 2004;18(8):503–8.CrossRefGoogle Scholar
  21. 21.
    Falck M, Hontzasch T, Krettek C. LISS (less invasive stabilization system) als minimalinvasive alternative bei distalen Femurfrakturen. Trauma Berufskrankh. 1999;1:402–6.CrossRefGoogle Scholar
  22. 22.
    Althausen PL, Lee MA, Finkemeier CG, Meehan JP, Rodrigo JJ. Operative stabilization of supracondylar femur fractures above total knee arthroplasty: a comparison of four treatment methods. J Arthroplast. 2003;18(7):834–9.CrossRefGoogle Scholar
  23. 23.
    Hierholzer C, von Ruden C, Potzel T, Woltmann A, Buhren V. Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures: a retrospective analysis. Indian J Orthop. 2011;45(3):243–50.CrossRefGoogle Scholar
  24. 24.
    Anglen J, Kyle RF, Marsh JL, et al. Locking plates for extremity fractures. J Am Acad Orthop Surg. 2009;17(7):465–72.CrossRefGoogle Scholar
  25. 25.
    Ebraheim NA, Liu J, Hashmi SZ, Sochacki KR, Moral MZ, Hirschfeld AG. High complication rate in locking plate fixation of lower periprosthetic distal femur fractures in patients with total knee arthroplasties. J Arthroplast. 2012;27(5):809–13.CrossRefGoogle Scholar
  26. 26.
    Bong MR, Egol KA, Koval KJ, et al. Comparison of the LISS and a retrograde-inserted supracondylar intramedullary nail for fixation of a periprosthetic distal femur fracture proximal to a total knee arthroplasty. J Arthroplast. 2002;17(7):876–81.CrossRefGoogle Scholar
  27. 27.
    Herrera DA, Kregor PJ, Cole PA, Levy BA, Jonsson A, Zlowodzki M. Treatment of acute distal femur fractures above a total knee arthroplasty: systematic review of 415 cases (1981-2006). Acta Orthop. 2008;79(1):22–7.CrossRefGoogle Scholar
  28. 28.
    Wick M, Muller EJ, Kutscha-Lissberg F, Hopf F, Muhr G. Periprosthetic supracondylar femoral fractures: LISS or retrograde intramedullary nailing? Problems with the use of minimally invasive technique. Unfallchirurg. 2004;107(3):181–8.CrossRefGoogle Scholar
  29. 29.
    Srinivasan K, Macdonald DA, Tzioupis CC, Giannoudis PV. Role of long stem revision knee prosthesis in periprosthetic and complex distal femoral fractures: a review of eight patients. Injury. 2005;36(9):1094–102.CrossRefGoogle Scholar
  30. 30.
    Cordeiro EN, Costa RC, Carazzato JG, Silva JS. Periprosthetic fractures in patients with total knee arthroplasties. Clin Orthop Relat Res. 1990;252:182–9.Google Scholar
  31. 31.
    Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF. Rotating hinged total knee replacement: use with caution. J Bone Joint Surg Am. 2007;89(8):1735–41.PubMedGoogle Scholar
  32. 32.
    Chen F, Mont MA, Bachner RS. Management of ipsilateral supracondylar femur fractures following total knee arthroplasty. J Arthroplast. 1994;9(5):521–6.CrossRefGoogle Scholar
  33. 33.
    Kassab M, Zalzal P, Azores GM, Pressman A, Liberman B, Gross AE. Management of periprosthetic femoral fractures after total knee arthroplasty using a distal femoral allograft. J Arthroplast. 2004;19(3):361–8.CrossRefGoogle Scholar
  34. 34.
    Saidi K, Ben-Lulu O, Tsuji M, Safir O, Gross AE, Backstein D. Supracondylar periprosthetic fractures of the knee in the elderly patients: a comparison of treatment using allograft-implant composites, standard revision components, distal femoral replacement prosthesis. J Arthroplast. 2014;29(1):110–4.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • John S. Hwang
    • 1
  • Cory Collinge
    • 2
  1. 1.Department of OrthopedicsCarolinas Medical CenterCharlotteUSA
  2. 2.Orthopedic Specialty AssociatesBen Hogan CenterFort WorthUSA

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