pDIFFIR: Geriatric Periprosthetic DIstal Femur: FIxation Versus Replacement

NCT ID: NCT05805774

Last Updated: 2025-12-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

148 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-10-17

Study Completion Date

2032-12-10

Brief Summary

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Periprosthetic distal femur fractures are a significant source of morbidity and mortality for elderly patients. One treatment option involved a surgical fixation with plates or nails, screws and cables/wires along the side of your fractured bone. The second method consists in replacing your knee joint with an artificial knee prosthesis (artificial knee joint).

The primary objective is to determine if acute distal femur replacement improves knee pain and functional outcomes compared to surgical fixation. Secondary outcomes are mortality, reoperation, complications, post-operative pain and quality of life. A health economic analysis will be conducted to assess the cost-effectiveness of both treatments.

A total of 148 patients (74/group) will be enrolled in the study.

Detailed Description

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Conditions

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Distal Femur Fracture Periprosthetic Fracture Around Prosthetic Joint Implant Knee Knee Fracture

Keywords

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Periprosthetic Distal Femur fracture Knee replacement Surgical fixation Geriatric patients

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Group A - DFR

Group Type ACTIVE_COMPARATOR

Distal Femur Replacement

Intervention Type PROCEDURE

Knee surgery to remove the lower part of the femur and knee joint (where the broken bones are) and will replace them with an artificial knee joint (prosthesis).

Group B - ORIF

Group Type ACTIVE_COMPARATOR

Surgical fixation

Intervention Type PROCEDURE

Knee surgery to fix the fracture, that can use wires, nails, screws, pins or plates to health and fix the bones together.

Interventions

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Distal Femur Replacement

Knee surgery to remove the lower part of the femur and knee joint (where the broken bones are) and will replace them with an artificial knee joint (prosthesis).

Intervention Type PROCEDURE

Surgical fixation

Knee surgery to fix the fracture, that can use wires, nails, screws, pins or plates to health and fix the bones together.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* • 65 years and older

* Isolated periprosthetic fracture of the distal femur around a stable primary total knee arthroplasty (Lewis and Rorabeck Type 1-2)
* Fracture is acute (within 1 week from time of injury)
* Patient was ambulatory (with or without walking aids) in the community and at home prior to the injury
* Independent or moderately frail with score of 3 to 6 on the validated Clinical Frailty Scale
* Patient is able to read and understand the consent form document, or an interpreter is available to the patient at the time of consent and follow-up
* Patient or substitute decision maker is able to provide written informed consent to participate in the study

Exclusion Criteria

* • Active infection around the fracture (soft tissue or bone)

* Open fracture
* Bilateral femur fractures
* Major neuro-vascular injury requiring intervention, compartment syndrome and major neurologic injuries
* Pathological fracture excluding osteoporosis
* Ipsilateral total knee arthroplasty using revision components (varus/valgus constraint, stemmed femoral components)
* Periprosthetic distal femur fracture around a loose or failing primary total knee arthroplasty (Lewis and Rorabeck Type III)
* Ipsilateral primary partial knee or patellofemoral arthroplasty
* Previous ORIF of the distal femur or proximal tibia or patella
* Current or previous extensor mechanism (patellar tendon, quadriceps tendon, or patella fracture) disruption or repair
* Poly-trauma status (Injury Severity Score\>15) or any associated major injuries of the lower extremities that may hinder post-operative ambulation
* Medical contraindication to surgery
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mount Sinai Hospital, Canada

OTHER

Sponsor Role collaborator

Unity Health Toronto

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Amir Khoshbin, MD

Role: PRINCIPAL_INVESTIGATOR

Unity Health Toronto - St Michael's Hospital

Jesse Wolfstadt, MD

Role: PRINCIPAL_INVESTIGATOR

Mount Sinai Health Hospital

Locations

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St. Michael's Hospital

Toronto, Ontario, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Cassandra Tardif-Theriault

Role: CONTACT

Phone: 416-864-6060

Email: [email protected]

Facility Contacts

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Cassandra Tardif-Theriault

Role: primary

Other Identifiers

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23-001

Identifier Type: -

Identifier Source: org_study_id