Choosing the Appropriate Fixation Method for Periprosthetic Fractures After Total Knee Arthroplasty: Retrograde Nail or Locking Plate?

Abstract

Objective: This study aimed to compare retrograde intramedullary nailing (RIMN) and femoral locked plating (FLP) in the management of periprosthetic supracondylar femur fractures (PSFF) following total knee arthroplasty (TKA), focusing on fracture healing, blood loss, functional outcomes, and complication rates. 
Methods: Thirty-one patients surgically treated for PSFF between 2015 and 2021 were retrospectively analyzed. According to the fixation method, patients were divided into two groups: FLP (n=19) and RIMN (n=12). Group allocation was based on fracture pattern, distal fragment length, and prosthesis compatibility. Fractures were classified according to the Su system. Operative parameters, intraoperative blood loss, transfusion requirement, union time, complications, and functional outcomes (Knee Society Score, KSS) were evaluated. Statistical analysis was performed using SPSS 23.0, with a significance level of p<0.05. 
Results: No significant difference was found between groups in terms of demographics, fracture type, or complication rate (p>0.05). The RIMN group showed significantly lower intraoperative blood loss and transfusion requirements (p<0.001 and p=0.016, respectively). KSS and KSS-functional scores were significantly higher in the RIMN group (p=0.022 and p=0.028). There was no significant difference in union time between the two fixation methods. 
Conclusions Both fixation methods are effective for PSFF treatment; however, RIMN provides advantages in terms of reduced blood loss, lower transfusion needs, and superior postoperative functional outcomes. Surgical method selection should be individualized according to bone quality, fracture morphology, and prosthesis compatibility.

Keywords

• Periprosthetic supracondylar femur fracture
• Total knee arthroplasty
• Retrograde intramedullary nailing
• Locked plate fixation
• Orthopedic trauma

Ethical Statement

Written informed consent was obtained from all patients and/or their legal guardians for the inclusion of their clinical data and images in this scientific publication. The study protocol was in accordance with the Declaration of Helsinki and ethical approval was obtained from the Sakarya University Faculty of Medicine Clinical Research Ethics Committee (Approval no. E-43012747-050.04-481626-354).

Thanks

We would like to thank the orthopedic doctors at Sakarya Training and Research Hospital for their contributions.

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