KNEE Treatment of resistant nonunion of supracondylar fractures femur by megaprosthesis Raju Vaishya • Ajay Pal Singh • Rohit Hasija • Arun Pal Singh Received: 6 January 2010 / Accepted: 24 January 2011 / Published online: 11 February 2011 Ó Springer-Verlag 2011 Abstract Purpose Resistant nonunion of distal femoral fractures in the elderly is a great challenge to treat because it is often associated with multiple problems like poor bone quality, arthritis, disuse osteopenia, joint contractures, and implant failure. We treated ten patients with megaprosthesis and report the outcome. Methods Ten elderly patients of resistant nonunion of distal femoral fractures with arthritis knee were treated with megaprosthesis. The median patient age was 74 years (68–85 years). All these patients had undergone at least two prior operative procedures and were operated by us, 24–33 months following the first index surgery. Modular Resection System was used in all the patients. Results Eight patients were available for follow-up. Med- ian follow-up period was 4 years. Two patients required extended local wound care for wound skin necrosis. One patient sustained traumatic periprosthetic subtrochanteric fracture following a subsequent trauma. No thromboembolic complications were seen. All knees showed satisfactory alignment and range of motion. Postoperative, median knee society pain score, and knee society function score were 84 (80–88) and 88 (84–92) at last follow-up. Conclusion Megaprosthesis can be offered as a one-stage salvage procedure for difficult nonunion in distal femoral fractures associated with bone loss, osteoporosis, and sec- ondary knee arthritis. Level of evidence IV. Keywords Supracondylar fracture Á Resistant nonunion Á Megaprosthesis Á Osteoarthritis Á Arthroplasty Introduction Nonunion of supracondylar distal femoral fractures occur mostly in patients with poor bone quality or unfavorable fracture patterns. Internal fixation and prosthetic replace- ment are the described methods of treating nonunions [1, 5, 8]. In elderly patients with repeated failed attempts, reosteo- synthesis is not a feasible option due to poor bone stock. Total knee arthroplasty is a recognized therapeutic option but its efficacy and durability have not been established in supracondylar fractures where bone loss needs to be aug- mented with allograft [6, 11]. Distal femoral endopros- thesis or megaprosthesis has been reported as a option for treatment of acute fractures and nonunion of distal femoral fractures associated with bone loss [2, 4]. It permits early mobilization and weight bearing and also corrects the problem of knee instability, deformity, and osteoarthritis. Materials and methods Ten patients with nonunion of distal femur fracture with history of multiple failed surgeries, who were treated This study was done in Indraprastha Apollo Hospitals, Department of Orthopaedics, Delhi. R. Vaishya Á R. Hasija Department of Orthopaedics, Indraprastha Apollo Hospitals, Delhi, India A. P. Singh (&) Orthopaedic Surgeon, Punjab Civil Medical Services-1, Mukerian, Punjab, India e-mail: docajaypal@gmail.com A. P. Singh Swami Premanad Hospital, Mukerian, Punjab, India 123 Knee Surg Sports Traumatol Arthrosc (2011) 19:1137–1140 DOI 10.1007/s00167-011-1416-1