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

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.

Are Femoral Stems in Primary Total Knee Arthroplasty Cost Effective in High Fracture Risk Patients? A Risk Model and Cost Analysis

“…Furthermore, the results from a study conducted by Tarity et al [17] led to the authors conclusion that, for TKA patients, FS implants may be helpful in avoiding the complication of PPF. Finally, although not directly related to the prevention of PPF, one study found that patients who experience PPF can be successfully treated with revision TKA utilizing long-stemmed TKA [18].…”

“…Finally, although not directly related to the prevention of PPF, one study found that patients who experience PPF can be successfully treated with revision TKA utilizing longstemmed TKA. 18 While the overall incidence of PPF after TKA is relatively low, that number may be underestimated when looking specifically at the high fracture risk patient population. Previously identified risk factors for PPF after TKA include neurologic disease, chronic steroid use, rheumatoid arthritis, osteoporosis, female sex, and advanced age.…”

“…Finally, although not directly related to the prevention of PPF, one study found that patients who experience PPF can be successfully treated with revision TKA utilizing long-stemmed TKA. 18…”

RGB-D-Based Method for Measuring the Angular Range of Hip and Knee Joints during Home Care Rehabilitation

“…To this end, it is crucial to measure the range of motion (ROM) of the knee/hip. Unfortunately, in this context, lateral radiography is widely recognized as the gold standard [ 5 ], but for normal post-operative complete knee/hip arthroplasty examination, radiographs of the knee/hip in both acute flexion and extension (or ab/adduction for the hip) are not indicated due to the risk of overexposing the patient to radiation.…”

“…In a number of cases, doctors simply use a goniometer or an inclinometer for measuring the angular range when the patient is within the hospital structure and do not have any control on the patient movements during exercises at home. Both instruments are poorly accurate for this kind of measurement, since a digital inclinometer appreciates a 6° minimum significant difference while the goniometer-based measurement could lead to even larger errors [ 5 ].…”