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.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.otsr.2015.09.021 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Recommending Surgery Increases Patient Satisfaction with Arthroplasty Surgeons.
J Arthroplasty
January 2025
Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, California, USA. Electronic address:
Background: Current guidelines recommend shared decision-making in the treatment of hip and knee osteoarthritis, but the impact of individual treatment decisions on patient satisfaction scores is unknown. We hypothesized that clinic Press Ganey satisfaction ratings would be higher for patients who later underwent arthroplasty than patients who did not have surgery.
Methods: Press Ganey satisfaction surveys were obtained from all patient visits at a single academic institution's arthroplasty clinic from 2010 to 2018.
A Comparison of 90-Day Complication Rates Between Intra-incisional and Extra-incisional Pin Sites in Robotic Total Knee Arthroplasty.
J Arthroplasty
January 2025
Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021.
Introduction: Robotic-assisted total knee arthroplasty (TKA) platforms require tibial and femoral pins to support rigidly fixed navigation arrays. These pins can be placed inside or outside the primary incision. We sought to compare 90-day complication rates between three different pin configurations: all-outside, intra-incisional femur/extra-incisional tibia, and all-inside.
View Article and Find Full Text PDFA "1.5-Stage" Spacer Construct Using Revision Components for the Management of Periprosthetic Joint Infection of the Knee.
J Arthroplasty
January 2025
Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
Introduction: The two-stage surgical protocols used for the treatment of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) are associated with marked patient morbidity. As such, alternatives such as durable "1.5-stage" spacer constructs have gained popularity.
View Article and Find Full Text PDFMultidimensional Analysis of Preoperative Patient-Reported Outcomes Identifies Distinct Phenotypes in Total Knee Arthroplasty: Secondary Analysis of the SHARKS Registry in a Public Hospital Department.
J Knee Surg
January 2025
Department of Orthopaedics, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia.
Traditional research on total knee arthroplasty (TKA) relies on preoperative patient-reported outcome measures (PROMs) to predict postoperative satisfaction. We aim to identify distinct patient phenotypes among TKA candidates, and investigate their correlations with patient characteristics. Between 2017 and 2021, patients with primary knee cases at a metropolitan public hospital were enrolled in a clinical quality registry.
View Article and Find Full Text PDFAnti-platelet factor 4 antibody-mediated disorders: an updated narrative review.
Semin Thromb Hemost
January 2025
of Medicine, Universita degli Studi di Padova Scuola di Medicina e Chirurgia, Padova, Italy.
Anti-platelet factor 4 (PF4) antibody-mediated disorders are a heterogenous group of diseases characterized by the presence of highly pathogenic immunoglobulins G directed against PF4 and/or PF4/heparin complexes. These antibodies are able to activate platelets, neutrophils and monocytes, thus resulting in thrombocytopenia and a hypercoagulable state. Five different forms of anti-PF4 antibody-mediated disorders have been identified: i) classic heparin-induced thrombocytopenia (cHIT) mediated by heparin and certain polyanionic drugs; ii) autoimmune HIT (aHIT) characterized by the presence of anti-PFA/polyanion antibodies that can strongly activate platelets even in the absence of heparin; iii) spontaneous HIT (spHIT) characterized by thrombocytopenia and thrombosis without proximate exposure to heparin, with two subtypes: (a) post-total knee arthroplasty, and cardiac surgery using cardiopulmonary bypass or extracorporeal membrane oxygenation, and (b) post-infections; iv) vaccine-induced immune thrombotic thrombocytopenia (VITT) characterized by thrombocytopenia, arterial and venous thrombosis, or secondary hemorrhage after receiving adenoviral vector vaccines for COVID-19; v) VITT-like disorders triggered by adenoviral infections.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!