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Does primary total knee arthroplasty for acute knee joint fracture maintain autonomy in the elderly? A retrospective study of 21 cases - 08/12/15

Doi : 10.1016/j.otsr.2015.09.021 
F. Boureau a, b, , K. Benad a, b, S. Putman a, b, G. Dereudre a, b, G. Kern a, b, C. Chantelot a, b
a Service de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France 
b Université Lille–Nord-de-France, Lille, France 

Corresponding author at: Service de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France.

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Abstract

Introduction

Due to poor results and failure encountered in osteosynthesis of peri-articular fracture of the knee, arthroplasty may be suggested to osteopenic elderly subjects. All osteosynthesis techniques entail loss of independence and are associated with elevated mortality. No studies definitively establish better management of such fractures.

Hypothesis

Total arthroplasty provides better autonomy after peri-articular fracture of the knee.

Material and method

Seventy-nine patients aged over 65years were operated on for peri-articular fracture of the knee between April 2008 and March 2013. In 21 cases, treated by a single surgeon, total knee arthroplasty was performed in view of osteopenia or osteoarthritis. Mean age was 79years (range, 68–96years). There were 10 distal femoral and 11 proximal tibial fractures. Mean follow-up was 31months (range, 9–68months). Cases of pathologic fracture, failed osteosynthesis and non-operative management were excluded. All patients showed severe osteopenia on radiology and half already had advanced osteoarthritis.

Results

One-year mortality was 14%. At last follow-up, the revision rate was 9.5%. Fifteen patients were followed up. Mean Parker score fell from 7.2 (range, 2–9) preoperatively to 4.6 (range, 0–9) at last follow-up, indicating loss of independence. At follow-up, mean IKS score was 116.6 (range, 0–192) with mean IKS knee score of 78.4 (range, 0–100) and IKS function score of 38.2 (range, 0–100). Mean Oxford score was 36/60 (range, 18–53). Global IKS and IKS function scores were significantly better in case of ASA-2 than ASA-3 (P<0.05). There was no difference between femoral and tibial fractures in terms of IKS or Oxford score or loss of independence.

Discussion

Total knee arthroplasty can be considered for peri-articular fracture of the knee in osteopenic geriatric patients. Although surgical revision was less frequent than after osteosynthesis and resumption of weight-bearing was immediate, autonomy was still impaired. Mortality was comparable to other reports.

Level of evidence

IV, retrospective study.

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Keywords : Knee, Joint fracture, Total knee arthroplasty, Osteoporosis, Peri-articular


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Vol 101 - N° 8

P. 947-951 - décembre 2015 Regresar al número
Artículo precedente Artículo precedente
  • Cruciate-sacrificing total knee arthroplasty and insert design: A radiologic study of sagittal laxity
  • B. Appy Fedida, E. Krief, E. Havet, P. Massin, P. Mertl
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