Objective: 

Our primary objectives were to (1) determine the rate of requiring conversion to arthroplasty after open reduction internal fixation (ORIF) of geriatric distal femur fractures and (2) compare 10-year reoperation rates after ORIF versus primary arthroplasty for geriatric distal femur fractures.

Design: 

Propensity-matched retrospective cohort study.

Setting: 

All centers participating in the California Office of Statewide Health Planning and Development (OSHPD) database.

Patients/Participants: 

All patients 65 years of age or older who underwent operative management of a distal femur fracture between 2000 and 2017.

Intervention: 

ORIF, total knee arthroplasty (TKA), or distal femur replacement (DFR).

Main outcome measurements: 

Reoperation.

Results: 

A total of 16,784 patients with geriatric distal femur fracture were identified, of which 16,343 (97.4%) underwent ORIF. The cumulative incidence of conversion to arthroplasty within 10 years of ORIF was found to be 3.5%, with young age and female sex identified as risk factors for conversion. There was no significant difference in 10-year reoperation-free survival rate between propensity-matched patients undergoing ORIF versus primary arthroplasty (94.5% vs. 96.2%, P = 0.659). There were no differences in short-term complication or readmission rates between matched treatment cohorts, but arthroplasty was associated with a higher rate of wound infection within 90 days (2.0% vs. 0.2%, P = 0.011).

Conclusions: 

The 10-year cumulative incidence of conversion to arthroplasty after ORIF was found to be low. There was no significant difference in long-term reoperation-free survival rates between patients undergoing ORIF versus primary arthroplasty. Primary arthroplasty was associated with significantly higher rates of acute wound or joint infection.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.