Hinged total knee arthroplasty for fracture cases: Retrospective study of 52 patients with a mean follow-up of 5 years - 05/04/20

Doi : 10.1016/j.otsr.2019.11.029

Pascal Kouyoumdjian ^a,⁎ , Rémy Coulomb ^a, Adrien d’Ambrosio ^b, Salomé Ravoyard ^a, Etienne Cavaignac ^c, Gilles Pasquier ^d, Matthieu Ehlinger ^b
the SOFCOT^e
^a Service de chirurgie orthopédique et traumatologie, Chirurgie du rachis, CHRU de Nîmes, CHU Nîmes, 4, rue du Professeur Robert-Debré, 30029 Nîmes, France
^b Service de chirurgie orthopédique et de traumatologie, Hôpital de Hautepierre, CHU Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
^c Service de chirurgie orthopédique et traumatologie, CHU Toulouse, Hôpital Pierre-Paul Riquet, place du Docteur Baylac - TSA 40031, 31059 Toulouse, France
^d Service orthopédie D, CHRU de Lille, Cite hospitalière, 2, avenue Oscar Lambret, 59000 Lille, France
^e 56, rue Boissonade, 75014 Paris, France

^⁎Corresponding author.

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Abstract

Introduction

Hinged total knee arthroplasty (hTKA) is one of the treatment options available for complex fractures around an intact knee or an existing implant. The primary objective of this multicenter study was to evaluate the medium-term outcomes of hTKA for fractures. The secondary objective was to analyze the complications and risk factors based on fracture type, predisposition and time to surgery. We hypothesized that outcomes would be satisfactory, despite the context, and comparable to published data although impacted by significant mortality and morbidity.

Materials and methods

Within the framework of a symposium organized by the French Society of Orthopedic and Traumatology Surgery (SOFCOT), 52 patients from 11 hospitals were included retrospectively. All had undergone hTKA following a fracture event: recent fracture, postoperative course after a complex epiphyseal fracture on an intact knee, or periprosthetic fracture. Clinical outcomes (demographics, IKS score, Parker score, Devane score, time to surgery) and radiographic outcomes, along with complications were analyzed.

Results

Of the 52 patients included, 3 were lost to follow-up and 1 died early on. Thus, 48 patients with a mean age of 72 years (range, 31–95) were available for analysis at a mean follow-up of 59 months (range, 3–162). Forty of these patients (78%) had suffered a fracture to an intact knee and 12 (22%) had suffered a periprosthetic fracture. Of the 52 initial patients, 21 (40%) had early complications with 7 patients (19%) requiring surgical revision (5 surgical site infections, 1 extensor mechanism tear, 1 patellar dislocation). Sixteen patients (31%) developed late complications an average of 57 months after the hTKA implantation. All required surgical revision. There were 8 implant infections (15%), 3 cases of stiffness (6%), 2 extensor mechanism tears (4%) and 3 cases of loosening (6%). At a mean follow-up of 59 months, there was a 24-point improvement on the IKS pain scale (p=0.032). The postoperative activity level was unchanged in the patients who did not suffer a complication. The mortality rate was high (7/48; 15%).

Conclusion

Our hypothesis was confirmed since the outcomes were satisfactory, but mortality and morbidity were high. Performing hTKA remains an option in the post-fracture context, although surgeons must carefully consider the indications.