2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Periprosthetic Fractures Around Distal Femoral and Proximal Tibial Endoprostheses for Oncological Indications: A Comparison of Fixation Versus Revision Surgery

Jonathan Daniel Stevenson, FRCS (Tr&Orth), Birmingham UNITED KINGDOM
Jasprit Kaur, MBChB, Birmingham UNITED KINGDOM
Hartej Sur, FRCS Tr&Orth, Birmingham UNITED KINGDOM
Michael Parry, FRCS, Birmingham UNITED KINGDOM
Lee Jeys, FRCS, Birmingham UNITED KINGDOM

Royal Orthopaedic Hospital, Birmingham, UNITED KINGDOM

FDA Status Not Applicable

Summary

Our data suggests treating B1 or C fractures with ORIF and B2/3 fractures with a revision EPR achieves comparable results.

Abstract

Introduction

There is a paucity of literature describing outcomes of periprosthetic fractures (PPF) around distal femoral endoprostheses (DFEPRs) and proximal tibial endoprostheses (PTEPRs) for oncological indications. Our study compares outcomes of periprosthetic fractures treated with ORIF versus revision EPR.

Methods

Patients from 2007-2023 with periprosthetic fractures around DFEPRS and PTEPRs were identified from a single tertiary centre’s oncology database. Fractures were classified according to the unified classification system (UCS). Mean follow up was 7.5 years (range 1-20 years). Estimated survival was calculated using Kaplan Meier analysis and groups compared using log rank.

Results

37 fractures were identified in 33 patients. Non-operative intervention was utilised in eight undisplaced fractures with well-fixed stems, of which six occurred in the tibial shaft permitting plaster immobilisation. There was a single failure of non-operative management in the femur. Fractures undergoing ORIF were classified as B1 (69%) or C (31%) whereas revision EPR was indicated in B2/3 fractures (61.5%) or UCS C fractures with insufficient segmental bone length for osteosynthesis (38.5%). There were 7/16 failures in the ORIF group compared to 4/13 failures in the revision EPR group. There was no significant difference in the incidence of failure and revision surgery for the revision EPR versus the ORIF group (log rank, p=0.49); after five years estimated survival without further surgery due to failure for both groups was 60% (95% CI: 36.2% - 99.5%) and 61.7% (95% CI: 37.4% - 100%) respectively. There were three septic failures noted in the ORIF group and four failures noted in the revision EPR group. At ten years, survival following septic failure was 70% in both operative groups.

Conclusion

There is no difference in survival between operative groups at five years nor was there a difference in survival following septic failure at ten years. Our data suggests treating B1 or C fractures with ORIF and B2/3 fractures with a revision EPR achieves comparable results. Non-operative intervention remains for undisplaced fractures with well-fixed stems, particularly in the tibial shaft.