Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Surgery

Supervisor

Brent Lanting MD

Abstract

IPeriprosthetic distal femur fractures (PDFFs) following total knee arthroplasty (TKA) pose a growing challenge due to rising TKA rates and aging populations. This thesis examines the efficacy of open reduction and internal fixation (ORIF) with locking plates in 16 patients at Western University's London Health Sciences Centre, Canada. It utilizes Su and Rorabeck-Taylor classification systems and weight-bearing computed tomography (WBCT) to evaluate outcomes. All patients achieved radiographic union at one year without complications, yet patient-reported outcomes (KOOS Pain: 62.1, ADL: 47.9, KSS: 37.1, UCLA: 3.7) revealed moderate functional recovery with persistent limitations, showing no correlation with fracture type or screw placement. WBCT enhanced stability assessment. While ORIF ensures bone healing, the findings highlight the need for improved rehabilitation strategies. This study informs PDFF management, significant given Canada's projected $13 billion TKA burden by 2030.

Summary for Lay Audience

Knee replacement surgery is a common procedure that helps people with severe knee pain move better. But sometimes, the thigh bone (femur) can break near the knee implant—a problem called a periprosthetic femur fracture. This is more common in older adults and can be tricky to fix. This study explores how doctors can treat these breaks effectively and help patients recover.

The research focuses on a surgery called open reduction and internal fixation (ORIF), where metal plates and screws are used to hold the broken bone together as it heals. It also looks at two ways to categorize these breaks to guide doctors in choosing the best treatment. Additionally, a new tool called weight-bearing CT was used to see if the bone stays stable when patients stand, offering a clearer view of healing than older methods.

The study followed 16 patients treated at Western University’s London Health Sciences Centre. All their fractures healed without big issues like infections or extra surgeries. However, surveys showed many still had pain and struggled with everyday tasks like walking or climbing stairs.

This work matters because more people are getting knee replacements as they age, and these fractures are becoming more common. The study shows doctors how to improve treatment and care for patients with these breaks. It also points out that while the surgery fixes the bone, more help is needed for full recovery. Looking ahead, researchers could find new ways to ease pain and boost mobility after healing. By employing an innovative approach such as weight-bearing CT, this study provides an improved method for assessing recovery and lays the groundwork for future advancements in patient care.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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