Open reduction and internal fixation versus distal femoral replacement for periprosthetic distal femur fractures: a systematic review and meta-analysis.
meta_analysis · Level I
Where this comes from
- Record sourced from PubMed, PMID 41859491.
- Also identified by DOI 10.1097/OI9.0000000000000475 and PMC identifier 12999137.
- Licence recorded as CC BY-NC-ND.
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Abstract
This systematic review and meta-analysis compares open reduction and internal fixation (ORIF) versus distal femoral replacement (DFR) for periprosthetic distal femur fractures (PDFF), focusing on patient-reported outcomes, perioperative measures, functional results, and complications. Following PRISMA guidelines, PubMed, Embase, Scopus, and ScienceDirect were searched from January 2010 through November 2024 using keywords and MeSH strategies. Studies were eligible if they compared outcomes of ORIF and DFR for PDFFs and included ≥10 patients. Exclusion criteria included noncomparative studies, primary arthroplasty indications, and nonperiprosthetic fractures. Two independent reviewers extracted data on demographics, interventions, patient-reported outcomes, functional outcomes, and complications. Quality was assessed using the Newcastle-Ottawa Scale. Discrepancies were resolved by a third author. Random-effects meta-analyses were used to calculate pooled incidence rates and risk ratios with 95% confidence intervals. Heterogeneity was assessed via I<sup>2</sup> and Cochran Q. Thirteen retrospective cohort studies (n = 881; ORIF: 554, DFR: 327) were included. Knee Society Functional Scores were significantly better for ORIF vs DFR in the 2 studies reporting this metric (53 vs 39, <i>P</i> = 0.012; 52 vs 37, <i>P</i> = 0.027). There was no significant difference in Oxford Knee Scores (MD = -0.11, 95% confidence intervals: [-1.74, 1.52], <i>P</i> = 0.85). Mean time to weight bearing was shorter for DFR vs ORIF (2 vs 78 days, respectively; <i>P</i> = 0.04), although risk ratios for returning to preoperative mobility and achieving unassisted ambulation were statistically insignificant. The rate of reoperation was significantly higher for ORIF versus DFR (12% vs 7%, respectively; <i>P</i> = 0.048). ORIF may offer advantages in patient-reported functional outcomes compared with DFR. Although DFR allows for immediate weight bearing, this advantage may not imply superior long-term mobility. Level III.
Anatomy
- femur