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Article Abstract
Background: Distal femoral replacement (DFR) is a salvage option for massive femoral bone loss and is often performed in revision total knee arthroplasty (rTKA) that have undergone multiple prior procedures. This study aimed to report on a large cohort of DFRs performed at a tertiary referral institution regarding survivorship and risk factors for aseptic loosening, specifically the impact of a previously instrumented femoral canal.
Methods: Between 2016 and 2021, 105 patients undergoing rTKA to DFR with a minimum 2-year follow-up were identified. Kaplan-Meier estimates assessed survivorship free from all-cause reoperation, all-cause revision, and revision for aseptic loosening. Logistic regressions were conducted to assess potential risk factors for radiographic loosening and the need for revision.
Results: Prior femoral canal instrumentation was identified in 59% of cases, and 54% had undergone multiple prior procedures. The 2-year survivorship free from revision for aseptic loosening was 93%. The 2-year survivorship free from all-cause reoperation was 87% for native canals and 59% for previously instrumented canals (P = 0.008). The 2-year survivorship free from all-cause revision was 100 and 81%, respectively (P = 0.014). Regression analysis found re-rTKA (odds ratio [OR] = 18.3, P = 0.006), prior femoral canal instrumentation (OR = 14.6, P = 0.01), and prior femoral canal cementation (OR = 8.2, P = 0.007) to be risk factors for aseptic loosening.
Conclusions: A DFR for rTKA had high 2-year survivorship free from revision for aseptic loosening (93%). Regression analyses revealed multiple risk factors for aseptic femoral component loosening with a previously instrumented femoral canal, resulting in a 2.8-times higher rate of reoperation, a 10.5-times higher rate of all-cause revision, and an 11-times higher rate of aseptic loosening. Future research on fixation strategies in sclerotic, previously instrumented femoral canals should be prioritized to reduce the risk of fixation failure in this high-risk cohort.
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