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Total Femur Arthroplasty for Complex Periprosthetic Fracture

February 10, 2018

Contributors: Omar A Behery, MD; Amos Dai, BS; Dylan Lowe, MD; Amy Wasterlain, MD; William John Long, MD; William John Long, MD

2018 HONORABLE MENTION Introduction: Although total femur arthroplasty traditionally has been used to manage bone tumors of the thigh, it is becoming a versatile and effective treatment option for the management of complex periprosthetic femur fractures. Total femur arthroplasty is indicated in adults with a periprosthetic fracture who have severe bone loss or comminution that precludes plate fixation and adults in whom a two-stage salvage procedure is necessary for the management of persistent periprosthetic infection. Methods: This video demonstrates total femur arthroplasty in an 86-year-old woman with a periprosthetic distal femur fracture at the junction of a long diaphyseal-fitting revision total hip arthroplasty stem and a primary total knee arthroplasty implant. She had undergone attempted cerclage fixation of the periprosthetic distal femur fracture at an outside institution; however, severe malunion with shortening, skin tenting, and subsidence of the total hip arthroplasty femoral stem occurred 2 months postoperatively. The video discusses relevant indications, surgical decision making, alternative procedures, technical tips, postoperative rehabilitation, outcomes, and relevant literature. Results: The patient did well and was able to ambulate with the use of a walker at 7 months postoperatively despite being wheelchair-bound preoperatively. Although complications did not occur in this patient, the major complications associated with total femur arthroplasty include infection, hip or knee dislocation, limb-length discrepancy, fracture or failure of the prosthesis, and abductor muscle failure. Conclusion: Total femur arthroplasty may be a useful salvage procedure for the management of complex periprosthetic femur fractures. This video provides viewers with critical information required to perform total femur arthroplasty and to perioperatively treat patients who undergo total femur arthroplasty.

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