{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:03:47Z","timestamp":1785434627968,"version":"3.56.0"},"reference-count":34,"publisher":"Open Medical Publishing","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n Background<\/jats:title>\n Periprosthetic fracture is a rare complication of arthroplasty but can have devastating consequences for the patient and presents a complex surgical challenge. Locking compression plate and retrograde intramedullary nail are both widely accepted surgical fixation techniques for distal femoral periprosthetic fractures around a total knee arthroplasty. Although there is still a need for further high-quality research into both techniques, there is even less literature concerning the use of distal femoral replacement to treat distal femoral periprosthetic fractures. Interest has been piqued in distal femoral replacements for the treatment of distal femoral periprosthetic fractures due to the theoretical advantages of immediate post-operative weight-bearing and lack of dependence on fracture union, but there are still understandably reservations about performing such an extensive and invasive procedure when an accepted alternative is available. This meta-analysis aims to evaluate the current literature to compare the complication rates and return to pre-operative ambulatory status of distal femoral replacement and locking compression plate.<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n A literature search was performed to identify articles related to the management of distal femoral periprosthetic fractures around a total knee arthroplasty in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Methodological quality was assessed using the methodological index for non-randomized studies (MINORS) criteria. Articles were reviewed, and data extracted for analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Five articles met the inclusion criteria, reporting on 345 periprosthetic fractures. The overall rates of complications for distal femoral replacement and locking compression plate were: re-operation (6.1% vs 12.1%), infection (3.0% vs 5.3%), mortality (19.7% vs 19.3%), and return to pre-operative ambulatory status (60.9% vs 71.8%) (respectively).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This meta-analysis shows no statistically significant difference in the rates of re-operation, infection, mortality or return to pre-operative ambulatory status when comparing distal femoral replacement to locking compression plate.<\/jats:p>\n <\/jats:sec>","DOI":"10.52965\/001c.94574","type":"journal-article","created":{"date-parts":[[2024,4,22]],"date-time":"2024-04-22T21:57:02Z","timestamp":1713823022000},"source":"Crossref","is-referenced-by-count":3,"title":["Distal femoral replacement for the treatment of periprosthetic distal femoral fractures around a total knee arthroplasty: a meta-analysis"],"prefix":"10.52965","volume":"16","author":[{"given":"Matthew J","family":"Wood","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/043j9bc42","id-type":"ROR","asserted-by":"publisher"}],"name":"Royal National Orthopaedic Hospital","department":["Joint Reconstruction Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talal","family":"Al-Jabri","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/041kmwe10","id-type":"ROR","asserted-by":"publisher"}],"name":"Imperial College London","department":["Trauma and Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Stelzhammer","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01ckbq028","id-type":"ROR","asserted-by":"publisher"}],"name":"Whittington Hospital","department":["Trauma and Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Brivio","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00rsqg119","id-type":"ROR","asserted-by":"publisher"}],"name":"King Edward VII Hospital","department":["Trauma and Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Donaldson","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/043j9bc42","id-type":"ROR","asserted-by":"publisher"}],"name":"Royal National Orthopaedic Hospital","department":["Joint Reconstruction Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A","family":"Skinner","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/043j9bc42","id-type":"ROR","asserted-by":"publisher"}],"name":"Royal National Orthopaedic Hospital","department":["Joint Reconstruction Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Barrett","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00rsqg119","id-type":"ROR","asserted-by":"publisher"}],"name":"King Edward VII Hospital","department":["Trauma and Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"30777","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"issue":"2","key":"ref1","doi-asserted-by":"publisher","first-page":"113","DOI":"10.55095\/achot2015\/016","article-title":"Quality of life and functional outcome of periprosthetic fractures around the knee following knee arthroplasty","volume":"82","author":"S. 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Hoellwarth","year":"2018","journal-title":"Injury","ISSN":"https:\/\/id.crossref.org\/issn\/0020-1383","issn-type":"print"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1302\/0301-620X.103B4.BJJ-2020-1710.R1","article-title":"Management of low periprosthetic distal femoral fractures","volume":"103-B","author":"L.A., et al. Ross","year":"2021","journal-title":"Bone Joint J"},{"issue":"5","key":"ref18","doi-asserted-by":"publisher","first-page":"1571","DOI":"10.1016\/j.arth.2016.12.013","article-title":"Predictors of Functional Recovery Following Periprosthetic Distal Femur Fractures","volume":"32","author":"John A. 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