Distal Femoral Fractures in the Elderly: To Fix or Replace? A Multicentre Comparison of Outcomes

Distal femoral arthroplasty is increasingly being used in the management of distal femoral fractures in the elderly, particularly for highly comminuted fractures with poor bone stock. We sought to compare the outcomes of this procedure with conventional methods of fixation. Data were retrospectively collected for all procedures that had been performed for distal femur fractures in 2 centres over a 2 year period between 1/12/2020 and 30/11/2022. Open fractures and periprosthetic fractures were excluded. 17 patients underwent distal femoral replacement (DFR) during this period and 50 underwent fixation with either a distal femoral locking plate (n=22), a retrograde nail (n=22), both a retrograde nail and a distal femoral locking plate (n=3) or cannulated screw fixation (n=3). Both groups had a mean age of 78 with a greater proportion of females than males. Early surgery (<36 hours) was more common in the fixation group (p<0.005) and these patients also had a shorter length of stay in the acute hospital (mean 13 days vs 29 days, p<0.05). A greater proportion of patients who underwent fixation returned to their own home (31% vs 11%, p<0.0005). Inpatient death was more common in the DFR group (2% vs 11%, p<0.05). Post-operative full weight bearing status was more common in the DFR group (P<0.005). 30 day, 90 day, 180 day, 1 year and 2 year mortality rates showed non-significant differences between the two groups. Although DFR patients were more likely to be full weight bearing post operatively, they have a higher rate of inpatient death, a longer length of stay and were less likely to return to their own home after discharge. The conclusions that we can draw from this project are limited by the small sample size and the next stage is currently in progress where similar data is being collated across another trauma unit.