Revision Surgery After Failed Fixation of Periprosthetic Distal Femur Fractures: Nail–Plate Combination Versus Double Plating

<i>Background and Objectives</i>: The aim of this study was to compare the clinical and radiological outcomes of the nail-plate combination (NPC) and double-plate (DP) fixation techniques in revision surgery performed after fixation failure of periprosthetic distal femur fractures. <i>Materials and Methods</i>: Patients who underwent revision surgery for periprosthetic distal femur fractures following fixation failure between 2018 and 2023 at a tertiary referral center were retrospectively reviewed. Based on the surgical technique, patients were divided into two groups: NPC group (<i>n</i> = 27) and DP group (<i>n</i> = 45). Demographic characteristics, operative time, intraoperative blood loss, and fluoroscopy time were recorded. Radiological evaluation included union time, while clinical outcomes were assessed with the Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36) health survey. Complications (infection, thromboembolism, implant failure, nonunion, malalignment), reoperation, and 1-year mortality rates were also analyzed. <i>Results</i>: The NPC group had significantly shorter operative time (107 vs. 134 min, <i>p</i> < 0.001) and lower intraoperative blood loss (412 vs. 634 mL, <i>p</i> < 0.001). Hospital stay was shorter in the NPC group (6.9 ± 1.5 vs. 10.2 ± 3.3 days, <i>p</i> < 0.001). Mean union time was approximately three weeks shorter in the NPC group (15.4 vs. 18.8 weeks, <i>p</i> < 0.001). Functional outcomes (KSS, WOMAC, SF-36) did not differ significantly between groups. Complication rates were comparable; implant failure was the most frequent complication (NPC: 3.7% vs. DP: 13.3%). One-year mortality did not differ significantly (NPC: 7.4% vs. DP: 11.1%). <i>Conclusions</i>: Compared with DP fixation, the NPC technique offers clear perioperative advantages in revision surgery performed after fixation failure of periprosthetic distal femur fractures, including shorter operative time, reduced blood loss, and faster union. Functional outcomes and complication rates were similar between techniques. These findings suggest that the NPC may represent a safer and more feasible alternative.