A new classification of TKA periprosthetic femur fractures considering the implant type View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-11-25

AUTHORS

Johannes K. M. Fakler, Cathleen Pönick, Melanie Edel, Robert Möbius, Alexander Giselher Brand, Andreas Roth, Christoph Josten, Dirk Zajonz

ABSTRACT

BackgroundThe treatment aims of periprosthetic fractures (PPF) of the distal femur are a gentle stabilization, an early load-bearing capacity and a rapid postoperative mobilization of the affected patients. For the therapy planning of PPF a standardized classification is necessary which leads to a clear and safe therapy recommendation. Despite different established classifications, there is none that includes the types of prosthesis used in the assessment. For this purpose, the objective of this work is to create a new more extensive fracture and implant-related classification of periprosthetic fractures of the distal femur based on available classifications which allows distinct therapeutic recommendations.MethodsIn a retrospective analysis all patients who were treated in the University Hospital Leipzig from 2010 to 2016 due to a distal femur fracture with total knee arthroplasty (TKA) were established. To create an implant-associated classification the cases were discussed in a panel of experienced orthopaedists and well-practiced traumatologists with a great knowledge in the field of endoprosthetics and fracture care. In this context, two experienced surgeons classified 55 consecutive fractures according to Su et al., Lewis and Rorabeck and by the new created classification. In this regard, the interobserver reliability was determined for two independent raters in terms of Cohen Kappa.ResultsOn the basis of the most widely recognized classifications of Su et al. as well as Lewis and Rorabeck, we established an implant-dependent classification for PPF of the distal femur. In accordance with the two stated classifications four fracture types were created and defined. Moreover, the four most frequent prosthesis types were integrated. Finally, a new classification with 16 subtypes was generated based on four types of fracture and four types of prosthesis. Considering all cases the presented implant-associated classification (κ = 0.74) showed a considerably higher interobserver reliability compared to the other classifications of Su et al. (κ = 0.39) as well as Lewis and Rorabeck (κ = 0.31). Excluding the cases which were only assessable by the new classification, it still shows a higher interobserver reliability (κ = 0.70) than the other ones (κ = 0.63 or κ = 0.45).ConclusionsThe new classification system for PPF of the distal femur following TKA considers fracture location and implant type. It is easy to use, shows agood interobserver reliability and allows conclusions to be drawn on treatment recommendations. Moreover, further studies on the evaluation of the classification are necessary and planned. More... »

PAGES

490

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12891-017-1855-z

DOI

http://dx.doi.org/10.1186/s12891-017-1855-z

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1092977744

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/29178860


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86 periprosthetic fractures
87 planning
88 postoperative mobilization
89 prosthesis
90 prosthesis type
91 purpose
92 rapid postoperative mobilization
93 raters
94 recommendations
95 regard
96 reliability
97 retrospective analysis
98 stabilization
99 standardized classification
100 study
101 subtypes
102 surgeons
103 system
104 terms
105 therapeutic recommendations
106 therapy planning
107 therapy recommendations
108 total knee arthroplasty
109 treatment
110 treatment recommendations
111 type of fracture
112 type of prosthesis
113 types
114 work
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