Locked compression plating versus retrograde intramedullary nailing in the treatment of periprosthetic supracondylar knee fractures: a systematic review and meta-analysis

J Orthop Surg Res. 2021 Jan 22;16(1):78. doi: 10.1186/s13018-021-02222-x.


Background: Periprosthetic fractures of the distal femur above a total knee arthroplasty (TKA) have traditionally been managed by locking compression plating (LCP). This technique is technically demanding and is associated with high rates of non-union and revision. More recently, retrograde intramedullary nailing (RIMN) has been proposed as an acceptable alternative. This meta-analysis aims to evaluate clinical outcomes in patients with periprosthetic supracondylar femoral fractures who were treated with LCP and RIMN.

Methods: An up-to-date literature search was carried out using the pre-defined search strategy. All studies that met the inclusion criteria were assessed for methodological quality with the Cochrane's collaboration tool. Operative time, functional score, time-to-union, non-union rates and revision rates were all considered.

Conclusion: Ten studies with a total of 531 periprosthetic fractures were included. This meta-analysis has suggested that there is no significant difference in any of the outcome measures assessed. Further, more extensive literature is required on the subject to draw more robust conclusions.

Keywords: Fixation; Fracture; Periprosthetic; TKR; Trauma.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee
  • Bone Nails*
  • Bone Plates*
  • Female
  • Femoral Fractures / surgery*
  • Fracture Fixation, Internal / methods*
  • Fracture Fixation, Intramedullary / methods*
  • Humans
  • Male
  • Periprosthetic Fractures / etiology
  • Periprosthetic Fractures / surgery*
  • Treatment Outcome