Role of navigated total knee arthroplasty for acute tibial fractures in the elderly.

Purpose: The role of total knee arthroplasty (TKA) in acute tibial fractures with existing comminution/bone loss, osteoporosis or preexistent arthritis has been described in the literature. Many of these procedures necessitate the use of stems to off-load the component and augments/wedges to avoid overresection and hence restore the joint line. Conventional methods may not be consistently accurate in restoring the desired alignment within 3° of the anatomical axis in this complex scenario. Computer-assisted TKA has been demonstrated to reproducibly and accurately restore the mechanical axis and joint line in primary TKA. Literature review has sparse data on use of navigation in acute TKA.

Methods: 9 cases of acute tibial fractures (6 tibial plateau and 3 diaphyseal) were treated by navigated primary knee arthroplasty and followed up over 26-month duration.

Results: All fractures healed without notable complications. Mean range of movement was 114°. Mean Knee Society score was 84. Out of 9 cases 5 were graded as excellent, 3 good and 1 fair. All knees were corrected to within a mean of 1.7° of the calculated mechanical axis.

Conclusion: Total knee arthroplasty should be considered a treatment option for acute upper tibial fractures in the elderly with coexistent knee arthritis and poor bone stock. Computer-assisted navigation aids in restoration of mechanical axis and component positioning.