Distal Femoral Replacement for Acute Distal Femoral Fractures in Elderly Patients.

OBJECTIVES: To evaluate outcomes and complications using cemented modular distal femoral replacement in elderly patients with distal femoral fractures.
DESIGN: Retrospective chart review, case series.
SETTING: A Level 1 and Level 2 trauma center, both tertiary referral hospitals. PATIENTS/PARTICIPANTS: Eighteen patients older than 60 years (average age 77 years) who had cemented distal femoral replacement for distal femoral fractures (comminuted, intraarticular, osteoporotic, arthritic) between 2005 and 2013. Patients with previous knee surgery were excluded. INTERVENTION: Cemented modular distal femoral replacement. MAIN OUTCOME MEASURES: Implant status, complications, Knee Society Score, Musculoskeletal Tumor Society score, and Western Ontario and McMaster Osteoarthritis Index.
RESULTS: All patients were extremely or very satisfied with their outcomes. For patients with functional outcome data, Knee Society Score averaged 85.7 with a functional score of 35, Musculoskeletal Tumor Society score averaged 19.2, and Western Ontario and McMaster Osteoarthritis Index score averaged 23.1 at an average follow-up of 2.3 years. Range of motion was 1-99 degrees. Implant-related complications occurred in 2 patients (11%); one required revision to total femoral replacement because of periprosthetic fracture and the other had a deep infection that required exchange of the components. No patient had aseptic loosening or patellar maltracking. There were no perioperative deaths or late amputations.
CONCLUSIONS: Cemented modular distal femoral replacement is a viable treatment option in elderly patients that permits immediate full weight-bearing, with most patients returning to preoperative functional status. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.