Περίληψη:
Background: Femoral fracture may predispose the knee to the development
of post-traumatic arthritis by either a direct intraarticular injury or
residual limb malalignment. Malunion, intra-articular osseous defects,
limb malalignment, retained internal fixation devices, and compromised
surrounding soft tissues may in turn affect the outcome of total knee
arthroplasty (TKA) in these patients. The aim of our study was to
evaluate the result of TKA in patients with previous distal femoral
fracture. Methods: The results of 48 cemented condylar total knee
arthroplasties, performed between 1980 to 1998, in 47 patients with a
previous distal femoral fracture were reviewed. There were 37 females
and 10 males with an average age of 65 years (range, 19-84 years).
Follow-up averaged 6.2 years (range, 2-16 years). No patients were lost
to follow-up. Results: At the time of arthroplasty a femoral fracture
non-union was present in three knees, all of which were treated with a
long stem cemented femoral component and bone grafting. Malunion,
defined as angulation greater than 10 in the coronal plain or greater
than 15 in the sagittal plain, was present in 21 knees. Of these, six
underwent distal femoral osteotomy during TKA. In the remaining 15
patients, with a malunion, the deformity was addressed by alterations in
the orientation and location of bone resection. Other procedures were
commonly needed at the time of arthroplasty and included: lateral
retinacular release (22 knees), extensor mechanism realignment (eight
knees), and collateral ligament reconstruction (two knees). The mean
pre-operative Knee Society Scores were 40 (range, 0-80) for pain and 48
(range, 0-100) for function and improved significantly to a mean of 84
(range, 37-99) and 66 (range, 0-100) points, respectively, at the latest
follow-up (P<0.001). The knee arc of motion improved from a
pre-operative mean of 83-99 at the latest follow-up (P<0.004).
Post-operative manipulation under anesthesia for poor motion was carried
out in four knees. Two knees had aseptic loosening that required
subsequent revisions. Three knees developed deep infection which was
treated with debridement and retention of components in one knee,
arthrodesis in another, and eventual amputation in one knee.
Conclusions: Significant improvement in function and relief of pain is
seen in the vast majority of patients with previous distal femoral
fractures undergoing subsequent TKA. However, these patients are at
increased risk for restricted motion and perioperative complications
following TKA. Special efforts to preserve the vascularity of the skin
and subcutaneous tissues, restore limb alignment, ensure correct
component positioning, and achieve soft tissue balance may help minimize
the problems identified in this study. (C) 2002 Elsevier Science B.V.
All rights reserved.
Συγγραφείς:
Papadopoulos, EC
Parvizi, J
Lai, CH
Lewallen, DG
