Fixation techniques for periprosthetic femur fractures around total knee arthroplasty: a systematic review

There is no consensus regarding the treatment algorithm for the fixation of periprosthetic femur fractures (PFFs) around a total knee arthroplasty (TKA). Established methods of fracture fixation include locking plate (LP) or retrograde intramedullary nail (RIN) techniques. Newer fixation methods include the dual plate (DP) and the nail-plate combination (NPC) techniques. The purpose of this study is to review the literature on the outcomes of PFF fixation following TKAs over the past two decades. A systematic review was undertaken in the MEDLINE, Embase, and Cochrane databases in accordance with the PRISMA standards. Selection criteria included: patient cohort > 5 cases and minimum follow-up of 12 mo. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal Checklists for Cohort Studies and Case Series. Combined data analysis was performed with linear models and linear mixed effect models to compare the post-operative outcomes of the LP, RIN, and DP techniques. Our search identified 1086 studies and 31 were selected for final analysis. The number of the studies for the LP, RIN, DP, and NPC techniques were 23, 15, 4, and 1, respectively. There were no differences in the time to union, Knee Society Knee Score, or range of motion among the LP, RIN, and DP techniques. Although analysis did not demonstrate significant differences, it is limited by the lack of the available studies using the DP technique. Additionally, only one study for the NPC technique was retained after screening and data analysis was therefore not possible.