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Compared with secondary arthroplasty following
failed conservative therapy, first-line arthroplasty exerts more promising
effects in managing acute complex fractures of the knee.
The data of a study published in Orthopaedics
& Traumatology: Surgery & Research encouraged the use of total knee
arthroplasty (TKA) for reconstruction while treating complex articular
fractures due to its lower complication rates and improved functional outcomes.
Arthroplasty is commonly used to treat the acute fracture
of the proximal femur, elbow fracture but is less usual in complex knee
fracture. The arthroplasty was done with an objective to save the patient’s
life by limiting the decubitus complications. Internal fixation or even
nonoperatively treat most complex knee fractures in the elderly. There are,
however, good reasons, in the knee as much as for hip or shoulder fractures,
for treating certain acute complex fractures using an arthroplasty. Therefore,
in the present study Parratte S et al hypothesis that knee arthroplasty
could be a solution for acute fractures around the joint in elderly
osteoporotic patients.
Preoperative planning is much needed, to manage the appropriate materials required for intraoperatively. The basis of a surgical treatment requires to consider factors like bone defect management, choice of implant, implant fixation, and steps of reconstruction. For fractures of the distal femur, the first temporary reduction is a useful method to evaluate the rotation of femoral and level of the joint line. In the diaphyseal extension of the fracture, complementary internal fixation may be required to prevent inter-prosthetic fractures.
In the literature, the results of primary total
knee arthroplasty TKA for fracture are encouraging over arthroplasty following conservation
therapy due to the benefits it dispenses such as earlier full weight-bearing,
lower revision incidence, reduced complication rates and improved functional
outcomes. However, a frequent reduction in autonomy with higher 1-year
mortality, following complex femoral fractures was seen in the elders.
Therefore, the treatment requisite enticing knowledge, huge experience of
principles of prosthetic revision and optimized logistic preparations and
proper planning.
Orthop Traumatol Surg Res. 2018 Feb;104(1S):S71-S80
Primary total knee arthroplasty for acute fracture around the knee.
Parratte S et al.
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