Acute Primary Total Knee Arthroplasty for Proximal Tibial Fractures in Elderly

Document Type : RESEARCH PAPER

Authors

Orthopaedic Surgeon, Imam Hossein Hospital, Shahid Beheshti University of Medical sciences, Tehran, Iran

Abstract

Background: Proximal tibial fractures in elderly patients with osteoporosis or knee osteoarthritis (OA) are challenging
cases. In the current study, we present our experience with uncommon acute primary total knee arthroplasty (PTKA)
in this patient population.
Methods: PTKAs were performed following proximal tibial fractures in 30 consecutive patients over 60 years of age
with osteoporosis or knee OA between 2005 and 2009. Three constrained condylar knees (CCK) and no hinged knee
prosthesis were used. Patients were followed up for 4.5±1.1 years.
Results: Patients were discharged after 4.6±1.2 days. The postoperative Tegner activity scale (3.5±1.3) was improved
significantly compared to the preoperative scale (2.5±1.2) (P<0.001). The knee flexion range was significantly greater
in the operated side (106±13 degrees) compared to the uninjured knee (120±8 degrees) (P<0.001). The two sections
of knee society knee score (knee and function section) averaged 90.7±6.5 and 69.6±8.8, respectively. All patients
returned to their previous activities. Based on the visual analogue scale, the patients’ satisfaction and pain at final visit
were scored 8.1±1 and 1.5±1.2, respectively. No infection, thromboembolic events and loosening were observed.
Conclusion: PTKA following a proximal tibial fracture in elderly patients with osteoporosis or knee degeneration can be
considered as a safe alternative for open reduction and internal fixation. PTKA resulted in immediate weight-bearing,
improved functional status and patients’ satisfaction. However, functional outcomes were dependent on the general
condition of 24 the patient. Also, constrained knee prostheses were not necessary for a vast majority of the patients.

Keywords

Main Subjects

References

1. Hsu CJ, Chang WN, Wong CY. Surgical treatment of
tibial plateau fracture in elderly patients. Arch Orthop
Trauma Surg. 2001; 121(1-2):67-70.
2. Chin TY, Bardana D, Bailey M, Williamson OD, Miller
R, Edwards ER, et al. Functional outcome of tibial
plateau fractures treated with the fine-wire fixator.
Injury. 2005; 36(12):1467-75.
3. Rosen AL, Strauss E. Primary total knee arthroplasty
for complex distal femur fractures in elderly patients.
Clin Orthop Relat Res. 2004; (425):101-5.
4. Subasi M, Kapukaya A, Arslan H, Ozkul E, Cebesoy O.
Outcome of open comminuted tibial plateau fractures
treated using an external fixator. J Orthop Sci. 2007;
12(4):347-53.
5. Vermeire J, Scheerlinck T. Early primary total knee
replacement for complex proximal tibia fractures in
elderly and osteoarthritic patients. Acta Orthop Belg.
2010; 76(6):785-93.
6. Faldini C, Manca M, Pagkrati S, Leonetti D, Nanni M,
Grandi G, et al. Surgical treatment of complex tibial
plateau fractures by closed reduction and external
fixation. A review of 32 consecutive cases operated. J
Orthopaed Traumatol. 2005; 6(4):188-193.
7. Ma CH, Wu CH, Yu SW, Yen CY, Tu YK. Staged external
and internal less280 invasive stabilisation system
plating for open proximal tibial fractures. Injury.
2010; 41(2):190-6.
8. Singh S, Patel PR, Joshi AK, Naik RN, Nagaraj C, Kumar
S. Biological approach to treatment of intra-articular
proximal tibial fractures with double osteosynthesis.
Int Orthop. 2009; 33(1):271-4.
9. Zura RD, Browne JA, Black MD, Olson SA. Current
management of high-energy tibial plateau fractures.
Curr Orthopaed. 2007; 21(3):229-35.
10. Civinini R, Carulli C, Matassi F, Villano M, Innocenti
M. Total 264 knee arthroplasty after complex tibial
plateau fractures. Chir Organi Mov. 2009; 93(3):143-7.
11. Honkonen SE. Degenerative arthritis after tibial
plateau fractures. J Orthop Trauma. 1995; 9(4):273-7.
12. Wasserstein D, Henry P, Paterson JM, Kreder HJ,
Jenkinson R. Risk of total knee arthroplasty after
operatively treated tibial plateau fracture: a matchedpopulation-
based cohort study. J Bone Joint Surg Am.
2014; 96(2):144-50.
13. Suzuki G, Saito S, Ishii T, Motojima S, Tokuhashi Y,
Ryu J. Previous fracture surgery is a major risk factor
of infection after total knee arthroplasty. Knee Surg
Sports Traumatol Arthrosc. 2011; 19(12):2040-4.
14. Weiss NG, Parvizi J, Trousdale RT, Bryce RD, Lewallen
DG. Total knee arthroplasty in patients with a prior
fracture of the tibial plateau. J Bone Joint Surg Am.
2003; 85-A(2):218-21.
15. Bansal MR, Bhagat SB, Shukla DD. Bovine cancellous
xenograft in the treatment of tibial plateau fractures
in elderly patients. Int Orthop. 2009; 33(3):779-84.
16. Gerich T, Bosch U, Schmidt E, Lobenhoffer P, Krettek
C. Knee joint prosthesis implantation after fractures
of the head of the tibia. Intermediate term results of
a cohort analysis. Unfallchirurg. 2001; 104(5):414-9.
17. Malviya A, Reed MR, Partington PF. Acute primary
total knee arthroplasty for peri-articular knee
fractures in patients over 65 years of age. Injury. 2011;
42(11):1368-71.
18. Nau T, Pflegerl E, Erhart J, Vecsei V. Primary total
knee 285 arthroplasty for periarticular fractures. J
Arthroplasty. 2003; 18(8):968-71.
19. Nourissat G, Hoffman E, Hémon C, Rillardon L, Guigui
P, Sautet A. Total knee arthroplasty for recent severe
fracture of the proximal tibial epiphysis in the elderly
subject. Rev Chir Orthop Reparatrice Appar Mot.
2006; 92(3):242-7.
20. Roerdink WH, Oskam J, Vierhout PA. Arthroscopically
assisted osteosynthesis of tibial plateau fractures
in patients older than 55 years. Arthroscopy. 2001;
17(8):826-31.
21. Su EP, Westrich GH, Rana AJ, Kapoor K, Helfet DL.
Operative 305 treatment of tibial plateau fractures in
patients older than 55 years. Clin Orthop Relat Res.
2004; (421):240-8.
22. Frattini M, Vaienti E, Soncini G, Pogliacomi F. Tibial
plateau fractures in elderly patients. Chir Organi Mov.
2009; 93(3):109-14.
23. Schandelmaier P, Partenheimer A, Koenemann B,
Grün OA, Krettek C. Distal femoral fractures and LISS
stabilization. Injury. 2001; 32(Suppl 3):SC55-63.
24. Shah A, Asirvatham R, Sudlow RA. Primary resection
total knee arthroplasty for complicated fracture of
the distal femur with an arthritic knee joint. Contemp
Orthop. 1993; 26(5):463-7.
The Archives of Bone and Joint Surgery
Volume 5, Issue 5
September 2017
Pages 302-307

Files

History

  • Receive Date: 31 July 2016
  • Revise Date: 09 March 2017
  • Accept Date: 16 August 2016

Share

How to cite

Statistics