Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation.

Dariusz Grzelecki,Dariusz Marczak,Piotr Dudek,Jacek Kowalczewski,Marcin Tyrakowski,Kamil Kwolek,Łukasz Olewnik,Maria Czubak-Wrzosek

doi:10.3390/jcm10214926

Dariusz Grzelecki, Dariusz Marczak + Show 6 more

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https://doi.org/10.3390/jcm10214926

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Abstract

The aim of this study was to evaluate the bone union, complication rate, clinical and functional outcomes of long-stemmed total knee arthroplasty (TKA) in patients with periprosthetic femoral or tibial shaft fractures and in patients with femoral or tibial shaft fractures with coexisting advanced knee osteoarthritis (OA). This retrospective study comprised 25 patients who underwent surgery due to tibial or femoral shaft fractures: (1) with coexisting severe knee OA or (2) with a periprosthetic fracture requiring implant exchange. In all cases, fracture stabilization was performed intramedullary with the use of long-stemmed implants without the use of additional fixation material (plates, screws, or cerclage). Bone union was achieved in 22/25 patients (88%). One patient required revision with additional plate stabilization due to non-union, and asymptomatic partial bone union was observed in two cases. The group with periprosthetic fractures demonstrated good clinical (mean 73.1 ± 13.3) and moderate functional (mean 59.2 ± 18.8) outcomes in the Knee Society Scoring system (KSS). In the group with shaft fracture and coexisting OA significantly higher clinical (excellent results, mean 84.1 ± 11; p = 0.03) and functional (good results, mean 76.2 ± 20.6; p = 0.04) results were noted. There were no statistically significant differences in terms of range of motion (ROM) or complication rate between these two groups. One-stage TKA with a long-stemmed implant without the use of additional fixation material is an effective method for the treatment of femoral or tibial shaft fractures in patients who require joint replacement. Despite being technically demanding, the approach yields bone union and moderate to excellent clinical and functional outcomes with a relatively low complication rate.

Highlights

IntroductionThe incidence of total knee arthroplasty (TKA) is increasing worldwide, accompanied by a rise in periprosthetic fractures
The inclusion criteria comprised femoral or tibial shaft fractures according to Müller et al [16], in patients who required primary total knee arthroplasty (TKA) or rTKA
Various methods of osteosynthesis have been proposed in surgical treatment strategies, such as single or double plating systems, intramedullary nailing (IM) and rTKA

Summary

Introduction

The incidence of TKAs is increasing worldwide, accompanied by a rise in periprosthetic fractures. The estimated frequency of periprosthetic fractures after primary procedures varies from 0.3 to 2.5% [1,2], and it is related to the age and sex of the patient, fracture localization, time of occurrence, patient demographics and concomitant diseases [3,4,5]. The choice of treatment strategies depends on several factors, including fracture morphology, localization, bone quality, type of the used primary implant and its fixation to the bone [4]. Several methods of treatment, including open reduction and internal fixation (ORIF) with plate and/or nail, and rTKA can be applied [7,8,9]. In patients with loosened prosthesis, the fracture can occur at the level of the femur or the tibial shaft; it can be found at the top of the prosthesis stem, where it is difficult and technically demanding to achieve stable fracture fixation [10]

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