Acute primary total knee arthroplasty for peri-articular knee fractures in patients over 65 years of age
Introduction
Peri-articular knee fractures in the elderly are difficult to deal with because of poor bone quality, pre-existing arthritis, comminution and osteochondral damage at time of injury.1 A high 1-year mortality rate (22%) and significant decrease in function and quality of life have been noted in frail elderly patients who sustained supracondylar femoral fractures.2 The cause of failure of fixation in this group of patients is not technical failure of the implant but the poor bone quality.3 Failure of fixation after tibial plateau fractures has been associated with advancing age (>60 years) and severe osteoporosis.4 Honkonen5 noted the difficulty in achieving a stable fixation in this group, and the risk of losing the reduction was high despite internal fixation and bone grafting.
Any intervention in this category of patients should ideally allow immediate fracture stability for early mobilisation and early return to pre-injury functional level. Total knee replacement (TKR) is one viable option for this group of patients. We analysed our early results of primary TKR for peri-articular knee fractures with underlying osteoarthritis/osteoporosis in patients above the age of 65 years.
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Patients and methods
Between May 2000 and December 2008, 26 patients with peri-articular knee fractures and evidence of osteopenia or arthritis or osteoporosis were treated with primary total knee arthroplasty. Patients were identified from theatre records and operative data obtained from their medical notes. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) system. As per hospital protocol, patients were reviewed postoperatively in the clinic and scored according to the
Results
The mean age of the patients at the time of surgery was 80 years (67–92). The mean follow-up was 38.8 months (12–104), with minimum follow-up of 12 months. Left: right knee ratio was 16:10 and the female: male ratio was 25:1. The proximal tibia was fractured in 15 patients and the distal femur in 11 cases. All patients presented after a low-energy injury resulting in the fracture, except one patient who was involved in a road traffic accident. The fracture distribution is as shown in Table 1.
Discussion
TKR for peri-articular knee fractures is not a new concept but is seemingly under reported. We have demonstrated good results in these complex fractures in a challenging group of patients. TKR is a good pain-relieving operation with mean Knee Society knee score of 90.2. However, the overall functional status of these patients remained suboptimum as reflected by low Knee Society function score and SF-36 physical function score. This was possibly because of lower functional ability of this group
Conflict of interest
None.
Funding
None.
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