Challenging the myth - comparing early complications of native and periprosthetic distal femur fractures - The role of implant stability

Q: What was the study objective?

To compare patient characteristics, treatment strategies, and early complications between native and periprosthetic distal femur fractures using the Lewis–Rorabeck classification.

Q: How many patients were included, and how were they grouped?

A total of 152 surgically treated patients were analyzed: 90 with native distal femur fractures and 62 with periprosthetic distal femur fractures, subdivided into Lewis–Rorabeck Type I/II (49) and Type III (13).

Q: What differences were found in early complications between groups?

Periprosthetic fractures had a significantly lower overall complication rate versus the native group, and there were no differences in early postoperative complications, mobility at discharge, or length of hospital stay. Type III showed longer time to surgery and more frequent revision surgery.

Sep 30, 2026

Uploaded by Emma Wilson

Periprosthetic distal femur fractures are often viewed as more complex and morbid than native distal femur fractures, yet direct head-to-head evidence remains limited. This retrospective study compared patient characteristics, treatment strategies, and early complications using the Lewis–Rorabeck classification at a level I trauma center. Among 152 surgically treated patients, periprosthetic cases showed higher age and BMI, but similar early postoperative outcomes, while Lewis–Rorabeck Type III required longer time to surgery and more revision.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Introduction

Classification and treatment rationale

Methods

Study design and patient groups

Results

Patient characteristics and early outcomes

Conclusion

Clinical implications

Archives of Orthopaedic and Trauma Surgery (2026) 146:30 [https://doi.org/10.1007/s00402-025-06173-4](https://doi.org/10.1007/s00402-025-06173-4) RESEARCH Challenging the myth: comparing early complications of native and periprosthetic distal femur fractures. The role of implant stability Christopher Lampert1 · Leon Faust1 · Gautier Beckers1 · Adrian Cavalcanti Kußmaul1 · Boris Michael Holzapfel1 · Wolfgang Böcker1 · Carl Neuerburg1 · Florian Pachmann1 Received: 6 November 2025 / Accepted: 23 December 2025 © The Author(s) 2026 Abstract Introduction Periprosthetic distal femur fractures are often considered more complex and morbid than native distal femur fractures, yet few studies directly compare them. This study aimed to compare patient characteristics, treatment strategies, and early complications between native and periprosthetic distal femur fractures using the Lewis–Rorabeck classification. Methods We retrospectively analyzed 152 patients treated surgically for distal femur fractures at a level I trauma center. Cases included native fractures (n= 90) and periprosthetic distal femur fractures (n= 62), further divided into Lewis–Rorabeck Type I/II (n= 49) and Type III (n= 13) . Demographics, comorbidities, surgical details, and in-hospital complications were assessed. We conducted a multivariate analysis comparing native fractures with Lewis–Rorabeck Type I/II fractures, as well as comparing Type I/II with Type III fractures. Results Patients with periprosthetic fractures were older and had higher BMI than those with native fractures (p< 0.001) . Multivariate analysis showed no significant differences in surgery duration, mortality, mobility at discharge, transfusion needs, or revision rates between native distal femur fractures (AO/OTA Type A) and Lewis–Rorabeck Type I/II. The complication rate was significantly lower in the periprosthetic group (p = 0.029) . Lewis–Rorabeck Type III fractures showed significantly longer time to surgery (p= 0.015) and revision surgery was performed more frequently compared to Lewis–Rorabeck Type I/II fractures. However, no differences were observed in early postoperative complications, mobility at discharge, or length of hospital stay. Conclusion This study directly compares periprosthetic distal femur fractures stratified by implant stability to native distal femur fractures. The findings challenge the perception that periprosthetic fractures are universally more difficult to treat. Periprosthetic fractures achieve results comparable to native fractures. The increased complexity of Lewis–Rorabeck Type III fractures is reflected in prolonged time to surgery and an increased need for revision surgery. Keywords Periprosthetic fractures · Arthroplasty · Internal fixation · Reoperation · Femoral fractures · Postoperative complications 􀀍 Christopher Lampert [Christopher.Lampert@med.uni-muenchen.de](Christopher.Lampert@med.uni-muenchen.de)[ ](Christopher.Lampert@med.uni-muenchen.de)Leon Faust [Leon.Faust@med.uni-muenchen.de](Leon.Faust@med.uni-muenchen.de) Gautier Beckers [Gautier.Beckers@med.uni-muenchen.de](Gautier.Beckers@med.uni-muenchen.de)[ ](Gautier.Beckers@med.uni-muenchen.de)Adrian Cavalcanti Kußmaul [Adrian.kussmaul@med.uni-muenchen.de](Adrian.kussmaul@med.uni-muenchen.de)[ ](Adrian.kussmaul@med.uni-muenchen.de)Boris Michael Holzapfel [Boris.holzapfel@med.uni-muenchen.de](Boris.holzapfel@med.uni-muenchen.de) 1 Wolfgang Böcker [Wolfgang.boecker@med.uni-muenchen.de](Wolfgang.boecker@med.uni-muenchen.de) Carl Neuerburg [Carl.Neuerburg@med.uni-muenchen.de](Carl.Neuerburg@med.uni-muenchen.de)[ ](Carl.Neuerburg@med.uni-muenchen.de)Florian Pachmann [Florian.Pachmann@med.uni-muenchen.de](Florian.Pachmann@med.uni-muenchen.de) Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU Klinikum, Munich, Germany 1 3 Introduction The increasing number of total joint arthroplasties performed annually, driven by an

FAQs

What was the study objective?

To compare patient characteristics, treatment strategies, and early complications between native and periprosthetic distal femur fractures using the Lewis–Rorabeck classification.

How many patients were included, and how were they grouped?

A total of 152 surgically treated patients were analyzed: 90 with native distal femur fractures and 62 with periprosthetic distal femur fractures, subdivided into Lewis–Rorabeck Type I/II (49) and Type III (13).

What differences were found in early complications between groups?

Periprosthetic fractures had a significantly lower overall complication rate versus the native group, and there were no differences in early postoperative complications, mobility at discharge, or length of hospital stay. Type III showed longer time to surgery and more frequent revision surgery.

Sep 30, 2026

Uploaded by Emma Wilson