• Ehab Girgis, Christoph McAllen, and Jonathan Keenan.
• Department of Trauma and Orthopaedic Surgery, Derriford Hospital, Plymouth, UK. ehab.girgis@nhs.net.
• Eur J Orthop Surg Tr. 2018 Jan 1; 28 (1): 95-102.

PurposeDistal femoral periprosthetic fractures above a total knee replacement in elderly patients are technically challenging to treat. Bone quality is often poor, the fractures comminuted, and post-operative mobilisation is difficult. This study assesses the clinical, radiological and functional outcome of revision knee distal femoral replacement (DFR) in these fractures.MethodsWe identified 14 patients over 70 years of age (70-94) who underwent DFR for periprosthetic fractures above a knee replacement. All the 14 fractures were classified as Su type III. Clinical and radiological records were retrospectively reviewed. The mean of clinical follow-up was 27 months (8-46). Functional outcome was assessed using Oxford Knee Score and EQ-5D (UK English Version) score at a mean time of 35 months (20-65). The Knee Society patient category score was also evaluated.ResultsThe median post-operative knee flexion was 100° (range 90°-135°). Nine patients (64%) returned to their pre-fracture level of mobility or better. The median post-operative Oxford Knee Score was 27 (range 4-40). The median EQ-5D was 11 (range 6-12). Cognitive impairment negatively impacted the functional outcome in four patients. One patient died early post-operatively, and two patients had complications.ConclusionsDFR led to satisfactory outcome in our patients with a relatively low complication rate. In our experience, revision knee distal femoral replacement is an appropriate method to treat elderly patients who sustained periprosthetic Su et al. type III distal femoral fractures in association with poor bone stock, caused by osteoporosis and/or comminution.

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