Distal femoral fractures treated by hinged total knee replacement in elderly patients

Appleton, Paul; Moran, Matthew D.; Houshian, Shirzad; Robinson, C. M.

doi:10.1302/0301-620x.88b8.17878

Cited by 118 publications

(90 citation statements)

References 39 publications

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“…In determining which to use, surgeons must consider multiple factors, including bone quality, fracture morphology, patient age, etc. Furthermore, some authors postulate that a constrained knee prosthesis could be a useful alternative to internal fixation in treating selected elderly patients with these fractures [1]. In preliminary studies, we found that a cemented prosthetic hip stem significantly reduced femoral fracture strength [14].…”

Section: Discussionmentioning

confidence: 69%

What is the risk of stress risers for interprosthetic fractures of the femur? A biomechanical analysis

Lehmann

Rupprecht

Nuechtern

et al. 2012

International Orthopaedics (SICOT)

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Section: Discussionmentioning

confidence: 69%

What is the risk of stress risers for interprosthetic fractures of the femur? A biomechanical analysis

Lehmann

Rupprecht

Nuechtern

et al. 2012

International Orthopaedics (SICOT)

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“…Malvia et al, 53,54 reported a better functional outcome score with fewer complications regarding fractures at both the tibia and femur, but with little homogeneity in their implant choice. Appleton et al, 55 followed a similar patient cohort to ours, treated with three different hinged knee prostheses (2 with Kotz [Stryker-Howmedica, Newbury, UK], 38 with Guepar [StrykerHowmedica] and 14 using the Stanmore [Biomet, Bridgend, UK]). A similar surgical technique was used, but cement was used to "fill up" any bony deficit, rather than endoprosthetic replacement.…”

Section: Retrograde Im Fixationmentioning

confidence: 95%

A 3 year minimum follow up of Endoprosthetic replacement for distal femoral fractures — An alternative treatment option

Atrey

Hussain²,

Gosling³

et al. 2017

Journal of Orthopaedics

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Introduction: Although the use of an endoprosthesis for distal femoral fractures remains a valid treatment option the widespread use is in its infancy. Methodology: In this retrospective case series, we review cases of distal femoral fracture treated with endoprosthetic replacement (EPR). The outcomes we assessed were the time to start mobilising, the time to discharge, morbidity and mortality as well as an Oxford knee score to assess pain and function and also the early survivorship. 6 of the 11 from the cohort had existing Total Knee Replacements (TKRs) in situ. Results: There were 11 knees in our cohort with a mean age of 81.5 years (range 52-102 years). The median time to follow up was 3.5 years (range 1.6 to 5.5 years). The median times to theatre was 3 days and to discharge was 16 days. Oxford functional and pain scores were 32/48. Discussion: In the appropriate patient and fracture pattern, Endoprosthetic knee replacement is an excellent option in the treatment of distal femoral fractures whether associated with an existing TKR or not. The implant is more costly than traditional open reduction and internal fixation, but the earlier return to full mobility post-operatively may save on hospital/care home stay and free up hospital space and minimise complications.

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“…2,[6][7][8] Although distal femur replacing total knee replacement, angled blade plates, and other methods have been successfully used to treat distal femur fractures in the elderly patients, locked plating and intramedullary nailing remain the current standards of operative care. [9][10][11][12] Nevertheless, high rates of complications and mortalities continue to be reported in all methods of internal fixation for distal femur fractures in the elderly patients. 1,2,8,13 Although multiple studies have assessed the biomechanical properties, functional scores, and complication rates of surgical treatment for distal femur fractures in the elderly patients, few studies have investigated the patient's quality of life.…”

Section: Introductionmentioning

confidence: 99%

Do Elderly Patients Fare Worse Following Operative Treatment of Distal Femur Fractures Using Modern Techniques?

Shulman

Patsalos-Fox

Lopez

et al. 2014

Geriatr Orthop Surg Rehabil

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Background: The purpose of this study was to compare the functional outcomes and quality of life of older and younger patients with similarly treated distal femur fractures. Methods: We conducted an assessment of 57 patients who sustained distal femur fractures (Orthopaedic Trauma Association Type 33B, C) and underwent surgical treatment at our academic medical center. Patients were divided into 2 groups for analysis: an elderly cohort of patients aged 65 or older and a comparison cohort of patients younger than age of 65. A retrospective review of demographics, preoperative ambulatory status, radiographic data, and physical examination data was collected from the medical records. Follow-up functional data were collected via telephone at a mean of 2.5 years (range 6 months-8 years) using a Short Musculoskeletal Functional Assessment (SMFA). All patients underwent standard operative treatment of either nail or plate fixation. Results: There was no statistical difference in gender, fracture type, surgical technique, surgeon, or institution where the surgery was performed. The percentage of patients with healed fractures at 6-months follow-up was not significantly different between the cohorts. The elderly cohort had slightly worse knee range of motion at 3, 6, and 12 months postoperatively but there was not a statistically significant difference between the groups. The SMFA Daily Activity, Functional, and Bother indices were significantly worse in the older cohort (P < .01, P ¼ .01, P ¼ .02, respectively). However, there was no significant difference in the SMFA Emotional or Mobility indices. Conclusion: Despite lower quality of life and functional scores, this study suggests that relatively good clinical outcomes can be achieved with surgical fixation of distal femoral fractures in the elderly patients. Age should not be used as a determinate in deciding against operative treatment of distal femur fractures in the elderly patients.

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Distal femoral fractures treated by hinged total knee replacement in elderly patients

Cited by 118 publications

References 39 publications

What is the risk of stress risers for interprosthetic fractures of the femur? A biomechanical analysis

What is the risk of stress risers for interprosthetic fractures of the femur? A biomechanical analysis

A 3 year minimum follow up of Endoprosthetic replacement for distal femoral fractures — An alternative treatment option

Do Elderly Patients Fare Worse Following Operative Treatment of Distal Femur Fractures Using Modern Techniques?

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