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Foreword: Periprosthetic Fractures about the Knee
12 April 2013 (online)
It is a privilege to serve as guest editor of this volume regarding surgical techniques for periprosthetic fractures about the knee and to provide a manuscript regarding standard methods for internal fixation. Dr. Gregory Della Rocca sets the stage for this series of manuscripts with his outstanding overview of periprosthetic fractures about the knee. The incidence and risk factors for fractures about the femoral component of total knee arthroplasty (TKA) are detailed. Also discussed are periprosthetic fractures about patellar components of TKA. The overview is rounded out by a discussion of special circumstances for periprosthetic fracture about the knee including those about unicompartmental knee arthroplasty, fractures associated with the use of the reamer irrigator aspirator device, and fractures of the distal femur associated with antegrade femoral nailing fracture.
The article on locked plating and retrograde nailing highlights the indications and the subtle aspects of their respective techniques. Although locked plating of periprosthetic distal femur fractures has quickly become the de facto gold standard for treatment of these fractures, Drs. Ries and Marsh have very nicely outlined some of the limitations of locked plating. They describe a cutting edge variation, far cortical locking, that is ideally suited for treatment of distal femur fractures but may also be applied to any bridge plating construct. Far cortical locking is a technique used to equalize motion at the medial and lateral cortices. The appropriate case selection as well as a step-by-step description of the technical details and case examples provide the reader with a clear picture of this promising new technique.
There is a growing popularity of revision arthroplasty for the treatment of periprosthetic distal femur fractures. Dr. James Keeney presents the appropriate indications for this option as well as the critical steps for preoperative planning, implant selection, and fixation techniques. Furthermore, a step-by-step detailed account of the surgical technique is described for both the femoral and tibial component revision. Postoperative rehabilitation, complications, and outcomes complete the discussion of revision arthroplasty for purposes of distal femur fractures.
Mortality in the geriatric population after hip fracture is widely discussed in the orthopedic literature. This is recognized as a significant public health concern. Dr. Philipp Streubel points out that mortality rates for patients with periprosthetic distal femur fractures approach the rates of mortality seen for patients with hip fracture. He describes short-term mortality, long-term mortality, as well as the potential risk factors.
The reader, after reviewing these five manuscripts, will have a thorough understanding of the modern issues, treatment options, and the technical subtleties for management of patients with periprosthetic fractures around total knee arthroplasty.