Revision Knee Arthroplasty with Distal Femoral Replacement – Single Center Study

Introduction Distal femoral replacement (DFR) revision surgery represents significant cost to the healthcare systems as well as significant patient morbidity/mortality. A retrospective review of revision knee surgery with DFR would elucidate a treatment algorithm for patients with complex reconstructive issues. In this study, we review patients' health metrics to better understand indications and potential complications for DFR revision. The data can then provide insight to specific patient factors that may put patients at higher risk for revision surgery. Methods Seventy-one patients who underwent distal femoral replacement were gathered retrospectively using ICD-9/ICD-10 codes. Patient population was grouped based on periprosthetic fracture (PPF), aseptic loosening (ASL), and periprosthetic infection (PJI). Significant descriptors and metrics were gathered for each of these patient groups. Post-operative complications, revisions, and reoperations were then gathered for the three groups. Results PJI group had the highest percentage of complications at 54%. PPF had the lowest percentage of complications at 25%. The variables that contributed to the largest percentage of complications in all three groups were prosthetic joint infection and aseptic loosening. The PJI group had the largest number of reoperations at 54% and revisions at 31%. The average number of reoperations in the PPF was 1.25, while the average number of reoperations in the PJI and ASL group was three. Conclusions In summary, high rates of complications, particularly in the PJI group are concerning; the stabilization of survivorship beyond three years offers a degree of reassurance for both surgeons and patients. The ASL indication group presented the slowest onset time for both complications and revisions. The PJI Indication group was the quickest to onset for both complications and revisions making these patients a high-risk treatment group. Finally, this study showed that revisions with DFR serves as a viable surgical option for patients, especially patients suffering from periprosthetic fractures.