{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:45:19Z","timestamp":1790858719342,"version":"4.1.0"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2020,1,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Distal femoral replacement (DFR) is a salvage option for complex primary and revision total knee arthroplasty (TKA). Although excellent immediate fixation and weight-bearing are achieved, there is a paucity of data on long-term outcomes of TKA with DFR. The purpose of the present study was to determine implant survivorship, clinical outcomes, and radiographic results of TKAs with contemporary DFR components in a large series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We identified 144 consecutive TKAs performed with DFR for non-oncologic indications from 2000 to 2015 at a single academic institution. Indications for the index DFR included 66 (46%) for native (n = 11) or periprosthetic (n = 55) femoral fracture, 40 (28%) for staged treatment of periprosthetic joint infection, 28 (19%) for aseptic TKA loosening, and 10 (7%) for other indications. Porous metal cones were used to augment femoral fixation in 28 patients (19%) and tibial fixation in 38 patients (26%). Outcomes included cumulative incidence of revision and reoperation (utilizing a competing risk model), Knee Society scores, and radiographic results. The mean age at the time of index DFR was 72 years, and 65% of patients were female. The mean follow-up was 5 years (range, 2 to 13 years) for the 111 patients who did not undergo revision, had not died, and were not lost to follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The 10-year cumulative incidences of revision for aseptic loosening, all-cause revision, and any reoperation were 17.0%, 27.5%, and 46.3%, respectively. There was an increased risk of reoperation in patients who underwent index DFR for aseptic TKA loosening (hazard ratio [HR], 2.30; p = 0.026) or periprosthetic joint infection (HR, 2.18; p = 0.022) compared with periprosthetic or native femoral fractures. However, there was no difference in risk of revision for aseptic loosening or all-cause revision based on the original operative indication. The mean Knee Society score increased from 45 preoperatively to 71 at the time of the latest follow-up (p &lt; 0.001). Radiographic loosening was observed in 8 unrevised DFRs (7%). There were 7 above-the-knee amputations performed at the time of the final follow-up, all for intractable periprosthetic joint infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>TKAs with contemporary DFR had high 10-year cumulative incidences of both revision and reoperation, underscoring the salvage nature of this procedure as a final reconstructive option. Most patients experienced substantial clinical improvements with this end-stage revision procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.19.00489","type":"journal-article","created":{"date-parts":[[2019,10,9]],"date-time":"2019-10-09T14:31:42Z","timestamp":1570631502000},"page":"45-51","source":"Crossref","is-referenced-by-count":64,"title":["Long-Term Results of Total Knee Arthroplasty with Contemporary Distal Femoral Replacement"],"prefix":"10.2106","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8629-7567","authenticated-orcid":false,"given":"Cody C.","family":"Wyles","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2756-1353","authenticated-orcid":false,"given":"Meagan E.","family":"Tibbo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0175-1095","authenticated-orcid":false,"given":"Brandon J.","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4572-7540","authenticated-orcid":false,"given":"Robert T.","family":"Trousdale","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1422-0306","authenticated-orcid":false,"given":"Daniel J.","family":"Berry","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2398-1724","authenticated-orcid":false,"given":"Matthew P.","family":"Abdel","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,10,9]]},"reference":[{"issue":"4","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1302\/0301-620X.89B4.18631","article-title":"Endoprosthetic replacement of the distal femur for bone tumours: long-term results","volume":"89","author":"Myers","year":"2007","journal-title":"J Bone Joint Surg Br."},{"issue":"10","key":"bib2-20230810","first-page":"2225","article-title":"Patellar complications following distal femoral replacement after bone tumor resection","volume":"88","author":"Schwab","year":"2006","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.arth.2016.06.006","article-title":"Open reduction vs distal femoral replacement arthroplasty for comminuted distal femur fractures in the patients 70 years and older","volume":"32","author":"Hart","year":"2017","journal-title":"J Arthroplasty."},{"issue":"1","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.arth.2013.04.012","article-title":"Supracondylar periprosthetic fractures of the knee in the elderly patients: a comparison of treatment using allograft-implant composites, standard revision components, distal femoral replacement prosthesis","volume":"29","author":"Saidi","year":"2014","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s11999-008-0329-x","article-title":"Distal femoral replacement in nontumor cases with severe bone loss and instability","volume":"467","author":"Berend","year":"2009","journal-title":"Clin Orthop Relat Res."},{"issue":"2","key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1302\/0301-620X.69B2.3818760","article-title":"Distal femoral replacement by custom-made prostheses. 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