Distal Femoral Replacement and Periprosthetic Joint Infectio
Distal femoral replacement (DFR) is commonly used to manage massive bone loss around the knee arising from aseptic loosening, periprosthetic joint infection (PJI) and distal femoral fractures. A number of studies report the outcome of DFR with considerable variation in long-term survivorship. This study investigated the outcome of DFR for patients with aseptic failures, fractures, and PJI.

A retrospective review of 182 patients who underwent DFR for non-oncological indications was conducted. Data collected included: indication, post-operative complications, re-operation, revision, and follow-up.

--The overall post-operative complication rate was very high at 36%. The most common complication was PJI (17%). The rate of re-operation for any cause was 29.7%, and the revision rate was 13.7%. The most common cause of re-revision was PJI.

--Revision-free survivorship of the DFR implant was 91.6% at one year, 87.9% at two years, 82.5% at five years, and 73.4% at ten years.

--Patients who had a prior-PJI had the lowest survivorship compared to patients undergoing DFR for management of periprosthetic fracture and mechanical loosening.

--Additionally, the prior-PJI group was at a 4-fold increased risk of post-operative PJI compared to the aseptic group.

To summarize, DFR is an excellent reconstructive alternative for individuals who have significant bone loss around the knee. Patients who undergo DFR, on the other hand, are at a significant risk of complications, reoperations, and failure.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0883540321006653?dgcid=rss_sd_all