A 65-year-old man with a cementless total knee replacement develops acute knee pain and swelling 8 years postoperatively after a fall. Radiograph shows a periprosthetic distal femoral fracture with the implant appearing well-fixed. This fracture is best classified using which system, and what is the primary determinant of treatment?
- A Gustilo-Anderson; open vs. closed nature
- B Su classification; prosthesis fixation status ✓
- C Vancouver classification; fracture stability
- D Neer classification; displacement degree
Correct answer: B. Su classification; prosthesis fixation status
Explanation
Periprosthetic distal femoral fractures after TKR are classified using the Su classification (Types I–III based on fracture level relative to the femoral shield). The most critical determinant of management is whether the implant is well-fixed or loose: a well-fixed implant with displaceable fracture is managed by ORIF, whereas a loose implant necessitates revision arthroplasty with a distal femoral replacement. Vancouver classification is used for femoral fractures around hip replacements.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.