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Supracondylar Periprosthetic Fracture Above a Total Knee Replacement Revised to a Distal Femoral Replacement

This case appears in the HSS publication Grand Rounds from HSS - Management of Complex Cases, Spring 2014 - Volume 5, Issue 1, Case 2

Case 2, presented by Charles N. Cornell, MD and Jason Blevins, MD, describes a 54-year-old female with a complex medical history who presented with a painful deformed right knee. As a child she suffered an intracranial bleed from a cerebral aneurysm that resulted in a left-sided spastic hemiparesis and a seizure disorder. As a young adult she developed Hodgkin’s Lymphoma requiring aggressive treatment with chemotherapy and an eventual bone marrow transplant to achieve a cure. As a result of the aggressive chemotherapy, marrow transplant and the need for anti-seizure medication, she developed osteoporosis. Upon presentation the patient had disabling right knee pain rendering her unable to ambulate without assistance. Right total knee replacement (TKR) was performed using posterior stabilized components (Figure 2). Four months following the TKR the patient fell in her home and sustained a grossly displaced supracondylar fracture at the level of the femoral prosthesis with considerable metaphyseal comminution (Figure 3). Due to osteopenia and poor bone stock excluding several options, a modular, hinged distal femoral replacement was performed. Post-operatively the patient recovered without complication. She regained 105 degrees of flexion with full extension and good extensor strength.

Read full case details in Volume 5, Issue 1 of Grand Rounds - Complex Cases.

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