Revision Arthroplasty Versus Open Reduction Internal Fixation for Distal Femur Periprosthetic Fractures: A Systematic Review

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Abstract

Introduction Distal femur periprosthetic fractures are a challenging complication following total knee arthroplasty (TKA). Primary surgical approaches are Revision Arthroplasty (RA) and Open Reduction Internal Fixation (ORIF). RA replaces unstable prosthetic components, while ORIF preserves the prosthesis. This review aims to evaluate the outcomes of RA and ORIF. Method This review followed PRISMA 2020 guidelines. Literature search was conducted across PubMed, Scopus, and Google Scholar. Data extraction and bias assessment were performed independently. Results Literature search resulted in 376 papers. After screening, 12 studies were included with a total of 526 patients, with 302 patients treated with ORIF and 224 with RA. ORIF patients showed a fracture union rate of 94.2% and RA patients 94.9%. Average time to union was 15.9 weeks for ORIF and 14.1 weeks for RA. Complication rates were 10% for ORIF and 10.3% for RA. Reoperation rates were 4.1% for ORIF and 4.5% for RA. Mortality rates were slightly higher in RA group (3.8%) compared to ORIF group (3.4%). ORIF patients scored higher on KSS but lower on OKS compared to RA patients. Discussion RA shows faster time to fracture union compared to ORIF, attributed to RA’s load-sharing design which supports early weight-bearing without compromising fracture stability or healing. Literature suggests that early mobilization may reduce morbidity and enhance ambulatory recovery. Complication, reoperation, mortality, and functional scores were similar in both groups. Conclusion Both ORIF and RA offer distinct advantages, depending on factors such as prosthetic stability and bone quality. Further researchs are required to establish proper guidelines.