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DeKeyser G, Thorne T, Martin BI, Haller JM. Changing Epidemiology of Distal Femur Fractures: Increase in Geriatric Fractures and Rates of Distal Femur Replacement. J Am Acad Orthop Surg 2024; 32:e1289-e1298. [PMID: 39231280 PMCID: PMC11624094 DOI: 10.5435/jaaos-d-24-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/16/2024] [Indexed: 09/06/2024] Open
Abstract
INTRODUCTION Distal femur fractures (DFFs) are associated with high complication and mortality rates in the elderly. Using the National Inpatient Sample and Medicare data, we describe trends in the incidence of DFFs by fixation type and associated healthcare costs. METHODS Annual population rates and volume of inpatient DFFs were estimated using Poisson regression with the US Census as a denominator. We used Current Procedural Terminology codes in Medicare patients to determine episode-of-care cost by treatment, classified as intramedullary nail, open reduction and internal fixation, and distal femur arthroplasty (DFR). RESULTS The annual incidence of DFFs in the United States is approximately 27.4 per 100,000. Admission for DFFs increased from 2002 to 2020, with the highest volume and rate in those aged 85 years and older. DFF incidence increased (1.95×) from 142 per 1 million (95% CI: 140 to 144) in 2006 to 281 per 1 million (95% CI: 278-284) in 2019. From 2012 to 2019, the percentage of DFFs treated by intramedullary nail increased from 6.8% to 8.4%, open reduction and internal fixation decreased from 89.9% to 76.6%, and DFR increased from 3.3% to 14.9%. DFR cost was significantly greater than other treatment choices across all years for initial inpatient admission costs and 90-day episode-of-care costs (all P < 0.0001). CONCLUSION DFF volume has increased in the past 20 years, predominantly in elderly patients. Greater than 4.5× increase was observed in the proportion of geriatric DFFs treated with DFR during this study period. The total cost of DFR treatment was consistently greater than other surgical treatments.
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Affiliation(s)
- Graham DeKeyser
- Oregon Health & Science University, Department of Orthopedic Surgery, Portland, OR, USA
| | - Tyler Thorne
- University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA
| | - Brook I. Martin
- University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA
| | - Justin M. Haller
- University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA
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Garabano G, Pereira S, Juri A, Bidolegui F, Pesciallo CA. Distal femur fractures in elderly treated with internal fixation or distal femoral replacement - retrospective cohort study on 75 patients assessing functional outcomes, reoperations, and mortality. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3775-3782. [PMID: 38869628 DOI: 10.1007/s00590-024-04027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/09/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE This cohort study aimed to describe the functional outcomes, complications, and mortality of patients over 65 with acute distal femur fractures treated with open reduction and internal fixation (ORIF) or distal femoral replacement (DFR). METHODS We retrospectively analyzed all patients older than 65, operated consecutively for a distal femur fracture treated with ORIF or DFR. We included 75 patients (9 33A, 5 33B, and 61 33C AO/OTA fractures), 55 treated with ORIF, and 20 with DFR. We used Parker's mobility index (PMI) to assess functional outcomes at 1, 3, and 12 months and study closure. We analyzed complications, reoperations, and mortality at 30 days, one year, and at the end of the study. RESULTS The PMI was significantly higher in the DFR group at months 1 (p = 0.023) and 3 (p = 0.032). We found no significant differences between cohorts at one year and the end of follow-up. Postoperative complications were significantly more frequent in the ORIF group (38.10% vs. 10%, p = 0.022). Reoperations were similar in both cohorts (p = 0.98). Mortality at one month was 4% and 20% at one year, and at the end of follow-up, there were no significant differences between groups. CONCLUSION The outcomes of this study suggest that DFR offers a faster functional recovery with lower complication rates than those treated with ORIF. Additionally, both options have similar reoperation and mortality rates. Appropriately designed studies are needed to define the best treatment strategy for this type of patient.
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Affiliation(s)
- Germán Garabano
- Orthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
- Scientific Advisory Committee, British Hospital of Buenos Aires, Buenos Aires, Argentina.
| | - Sebastian Pereira
- Orthopaedic and Trauma Surgery Department, Hospital Sirio Libanes, Campana 4658, C1419, Buenos Aires, Argentina
| | - Andres Juri
- Orthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Fernando Bidolegui
- Orthopaedic and Trauma Surgery Department, Sanatorio Otamendi, Azcuénaga 870, C115AAB, Buenos Aires, Argentina
| | - Cesar Angel Pesciallo
- Orthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
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Gwam CU, Harmody KC, Luo TD, Rosas S, Plates J. Geriatric Distal Femur Fractures Treated with Arthroplasty Are Associated with Lower Mortality but Greater Costs Compared with Open Reduction and Internal Fixation at 30 Days. J Knee Surg 2024; 37:538-544. [PMID: 38113909 DOI: 10.1055/a-2232-7826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Distal femur fractures (DFFs) are common injuries with significant morbidity. Surgical options include open reduction and internal fixation (ORIF) with plates and/or intramedullary devices or a distal femur endoprosthesis (distal femur replacement [DFR]). A paucity of studies exist that compare the two modalities. The present study utilized a 1:2 propensity score match to compare 30-day outcomes of geriatric patients with DFFs who underwent an ORIF or DFR. The National Surgical Quality Improvement Program data from 2008 to 2019 were utilized to identify all patients who sustained a DFF and underwent either ORIF or DFR. This yielded 3,197 patients who underwent an ORIF versus 121 patients who underwent a DFR. A final sample of 363 patients (242 patients with ORIF vs. 121 with DFR) was obtained after a 1:2 propensity score match. Costs were obtained from the National Inpatient Sample database using multiple regression analysis and validated with a 7:3 train-test algorithm. Independent samples t-tests and chi-square analysis were conducted to assess cost and outcome differences, respectively. Patients who received a DFR had higher transfusion rates than ORIF (p = 0.021) and higher mean inpatient hospital costs (p = 0.001). Subgroup analysis for patients 80 years of age or older revealed higher 30-day unplanned readmission (0 vs. 18.2%; p < 0.001) and 30-day mortality (0 vs. 18.2%; p < 0.001) rates for patients undergoing ORIF compared with DFR. The total number of DFR cases needed to prevent one ORIF-related 30-day mortality for DFR for patients 80 years of age was 6 (95% confidence interval: 3.02-19.9). The mean hospital costs associated with preventing one case of death within 30 days from operation by undergoing DFR compared with ORIF was $176,021.39. Our results demonstrate higher rates of transfusion and increased inpatient costs among the DFR cohort compared with ORIF. However, we demonstrate lower rates of mortality for patients 80 years and older who underwent DFR versus ORIF. Future studies randomized controlled trials are necessary to validate the results of this study.
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Affiliation(s)
- Chukwuweike U Gwam
- Department of Orthopaedics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Kristen Confroy Harmody
- Department of Orthopaedics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - T David Luo
- Department of Orthopaedics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
- Orthopaedics Northeast, Fort Wayne, Indiana
| | - Samuel Rosas
- Department of Orthopaedics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Johannes Plates
- Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Chuluunbaatar Y, Benachar N, Khroud-Dhillon H, Srinivasan A, Rojoa D, Raheman F. Early and 1-year mortality of native geriatric distal femur fractures: A systematic review and time-to-event meta-analysis. J Clin Orthop Trauma 2024; 50:102375. [PMID: 38495682 PMCID: PMC10943051 DOI: 10.1016/j.jcot.2024.102375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/27/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose Distal femur fractures (DFF) account for 6% of all femoral fractures and predominate in females. The current 1-year mortality of DFF is currently reported to be between 10 and 38%, a wide margin, and confounded by multiple factors including age, high energy mechanisms, pathological and periprosthetic fractures. The purpose of this study was to assess and determine all-cause mortality following geriatric native distal femur fractures at 30 days, six months and one year. Methods - The databases Cochrane CENTRAL, MEDLINE, EMBASE and NHS NICE Healthcare Databases Advanced Search Interface were searched in accordance with PRISMA guidelines. Original research articles relevant to mortality outcomes in native geriatric distal femur fractures following low energy trauma were included. A time-to-event data meta-analysis model was used to estimate pooled 30-day, six month and one-year mortality. A random effects meta-regression model was performed to assess potential sources of heterogeneity when studies reported on factors affecting the mortality observed in patients with geriatric distal femur fractures. Results - Thirteen studies were included in the meta-analysis with a mean age of 79.6 years. Eight studies reported the 30-day mortality of distal femur fractures in patients as a pooled estimate of 8.14%. Pooled estimate for 6-month mortality reported was 19.5% and the one-year mortality reported by ten studies was 26.10%. Time-to-event modelling showed that risk of mortality at one year in elderly patients with distal femur fractures was significantly higher HR = 4.31 (p < 0.001). When evaluating prognostic predictors, age and Type C fracture were predictive of highest mortality rates. Conclusions - This study is the first meta-analysis to evaluate the early and long-term mortality observed in elderly patients presenting with native distal femoral fractures. Through our results we have shown the quantifiable impact patient age and fracture configuration has on one-year mortality in this patient cohort.
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Affiliation(s)
- Yanjinlkham Chuluunbaatar
- Department of Orthopaedics, Lister Hospital, East and North Hertfordshire Trust, Corey Mill Lane, Stevenage, SG1 4AB , United Kingdom
| | - Nawal Benachar
- Department of Orthopaedics, Lister Hospital, East and North Hertfordshire Trust, Corey Mill Lane, Stevenage, SG1 4AB , United Kingdom
| | - Harnoor Khroud-Dhillon
- Department of Orthopaedics, Lister Hospital, East and North Hertfordshire Trust, Corey Mill Lane, Stevenage, SG1 4AB , United Kingdom
| | | | - Djamila Rojoa
- Leicester Royal Infirmary, Leicester, LE1 5WW, United Kingdom
| | - Firas Raheman
- Department of Orthopaedics, Lister Hospital, East and North Hertfordshire Trust, Corey Mill Lane, Stevenage, SG1 4AB , United Kingdom
- Royal Free London NHS Trust, London, NW3 2QG, United Kingdom
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Förch S, Lisitano L, Mayr E. Primary Total Knee Arthroplasty for Fractures Around the Knee. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:619-627. [PMID: 35654393 DOI: 10.1055/a-1807-7668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Primary arthroplasty for fractures of the femoral neck is a very common procedure and even the gold standard for the geriatric patient. In contrast, primary arthroplasty for perigenicular fractures is a rare event. On the other hand, it can be a therapeutic option, especially for geriatric patients with prior osteoarthritis or complex fractures and severe osteoporosis.The operative procedure can be complex and requires experience in primary and revision arthroplasty as well as suitable implants and good preoperative planning.There are case series reporting primary arthroplasty in a total of approximately 200 cases of both distal femoral and proximal tibial fractures. Complication rates are between 0 and 90% and mostly concern wound healing problems and infections. From a functional point of view, predominantly good results and a range of motion of 100° can be achieved.Primary arthroplasty can be a therapeutic option for selected cases of perigenicular fractures and gives good functional results. The most frequent complications are wound healing problems and infections.
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Affiliation(s)
- Stefan Förch
- Abteilung für Unfallchirurgie, Orthopädie, plastische und Handchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Leonard Lisitano
- Abteilung für Unfallchirurgie, Orthopädie, plastische und Handchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Edgar Mayr
- Unfallchirurgie, Orthopädie, Hand- und Plastische Chirurgie, Universität Augsburg Medizinische Fakultät, Augsburg, Deutschland
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Laubach M, Hildebrand F, Suresh S, Wagels M, Kobbe P, Gilbert F, Kneser U, Holzapfel BM, Hutmacher DW. The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective. J Funct Biomater 2023; 14:341. [PMID: 37504836 PMCID: PMC10381286 DOI: 10.3390/jfb14070341] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
The treatment of bone defects remains a challenging clinical problem with high reintervention rates, morbidity, and resulting significant healthcare costs. Surgical techniques are constantly evolving, but outcomes can be influenced by several parameters, including the patient's age, comorbidities, systemic disorders, the anatomical location of the defect, and the surgeon's preference and experience. The most used therapeutic modalities for the regeneration of long bone defects include distraction osteogenesis (bone transport), free vascularized fibular grafts, the Masquelet technique, allograft, and (arthroplasty with) mega-prostheses. Over the past 25 years, three-dimensional (3D) printing, a breakthrough layer-by-layer manufacturing technology that produces final parts directly from 3D model data, has taken off and transformed the treatment of bone defects by enabling personalized therapies with highly porous 3D-printed implants tailored to the patient. Therefore, to reduce the morbidities and complications associated with current treatment regimens, efforts have been made in translational research toward 3D-printed scaffolds to facilitate bone regeneration. Three-dimensional printed scaffolds should not only provide osteoconductive surfaces for cell attachment and subsequent bone formation but also provide physical support and containment of bone graft material during the regeneration process, enhancing bone ingrowth, while simultaneously, orthopaedic implants supply mechanical strength with rigid, stable external and/or internal fixation. In this perspective review, we focus on elaborating on the history of bone defect treatment methods and assessing current treatment approaches as well as recent developments, including existing evidence on the advantages and disadvantages of 3D-printed scaffolds for bone defect regeneration. Furthermore, it is evident that the regulatory framework and organization and financing of evidence-based clinical trials remains very complex, and new challenges for non-biodegradable and biodegradable 3D-printed scaffolds for bone regeneration are emerging that have not yet been sufficiently addressed, such as guideline development for specific surgical indications, clinically feasible design concepts for needed multicentre international preclinical and clinical trials, the current medico-legal status, and reimbursement. These challenges underscore the need for intensive exchange and open and honest debate among leaders in the field. This goal can be addressed in a well-planned and focused stakeholder workshop on the topic of patient-specific 3D-printed scaffolds for long bone defect regeneration, as proposed in this perspective review.
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Affiliation(s)
- Markus Laubach
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Sinduja Suresh
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Michael Wagels
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia;
- The Herston Biofabrication Institute, The University of Queensland, Herston, QLD 4006, Australia
- Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, QLD 4102, Australia
- Department of Plastic and Reconstructive Surgery, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia
- The Australian Centre for Complex Integrated Surgical Solutions, Woolloongabba, QLD 4102, Australia
| | - Philipp Kobbe
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Fabian Gilbert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Boris M. Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Dietmar W. Hutmacher
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Max Planck Queensland Centre (MPQC) for the Materials Science of Extracellular Matrices, Queensland University of Technology, Brisbane, QLD 4000, Australia
- ARC Training Centre for Cell and Tissue Engineering Technologies (CTET), Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
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Gendya AGMK, El-Zaher EZH, Zakaria ZM, Awad MES, Metwaly RGEA. Double Plating Fixation vs Distal Femoral Replacement in the Management of Distal Femoral Fractures in Geriatric Patients. Arthroplast Today 2023; 20:101113. [PMID: 36949829 PMCID: PMC10025122 DOI: 10.1016/j.artd.2023.101113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/24/2022] [Accepted: 01/24/2023] [Indexed: 03/24/2023] Open
Abstract
Background Distal femur fractures are considered challenging to manage, particularly in geriatric patients. Double plating (DP) is a technique that helps with earlier rehabilitation and return to preinjury level of activity. Distal femoral replacement (DFR) is an alternative technique in the management of these fractures that may help to solve problems like associated knee osteoarthritis, osteoporosis, and severely comminuted condyles. The current study compares the functional and radiological outcomes of DFR and DP in the management of these fractures among geriatric patients. Methods This randomized, comparative, interventional study was performed at a university hospital. A total of 30 patients who underwent DFR or DP after distal femur fractures (AO/OTA 33 A3, 33 C) were analyzed. The primary outcome was Knee Society Score (KSS), whereas secondary outcomes included postoperative complications rate, knee range of motion, reoperation rate, and operative time. Results No significant difference was observed between DFR and DP except for the knee component of the KSS at a 12-month interval (P = .03) and knee range of motion at a 12-month interval (P = .001), both of which were in favor of DP. No significant difference in postoperative complications (P = .06), reoperation rate (P = 1.00), or operative time (P = .06) was noted. Conclusions DFR and DP had comparable functional (KSS) and radiological outcomes with no significant difference in postoperative complications, reoperation rate, or operative time.
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Affiliation(s)
- Amr Gamaleldin Mahmoud Khalil Gendya
- Corresponding author. Department of Orthopaedic surgery, Ain Shams University, 143 Golf District, El-Sherouk City, Cairo, Egypt 62451. Tel.: (002)01147219920.
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Conrad T, Siewert N, Hofmann GO. [Primary total knee arthroplasty following trauma]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:936-945. [PMID: 36355062 DOI: 10.1007/s00113-022-01250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Primary total knee arthroplasty following complex knee joint trauma is only performed occasionally. In most cases a reconstruction is carried out. OBJECTIVE Are there confirmed indications for primary total knee arthroplasty following trauma? Which special features should be paid attention to? MATERIAL AND METHODS A selective literature search was carried out. The spectrum of indications and recommendations for action for primary total knee arthroplasty following trauma are presented, particularly against the background of demographic changes. RESULTS The spectrum of indications for primary total knee arthroplasty following trauma is limited. This has so far been carried out only in centers with the appropriate equipment and expertise, also for the management of complications but despite good overall results is still carried out only rarely. There is a lack of studies with large patient collectives. CONCLUSION Primary total knee arthroplasty following trauma is a safe procedure within the range of indications. The standard procedure for the vast majority of cases of complex knee trauma is a reconstruction.
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Affiliation(s)
- Thomas Conrad
- Klinik für Unfall- und Wiederherstellungschirurgie, Funktionsbereich Arthroskopie, Gelenkchirurgie und Endoprothetik, BG Klinikum Bergmannstrost, Merseburger Str. 165, 06112, Halle (Saale), Deutschland.
| | - Natalie Siewert
- Klinik für Unfall- und Wiederherstellungschirurgie, Funktionsbereich Arthroskopie, Gelenkchirurgie und Endoprothetik, BG Klinikum Bergmannstrost, Merseburger Str. 165, 06112, Halle (Saale), Deutschland
| | - Gunther O Hofmann
- Klinik für Unfall- und Wiederherstellungschirurgie, Funktionsbereich Arthroskopie, Gelenkchirurgie und Endoprothetik, BG Klinikum Bergmannstrost, Merseburger Str. 165, 06112, Halle (Saale), Deutschland
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Deutschland
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Zhu C, Zhang C, Zhao Y, Yu G, Yu L. Modified Masquelet Technique Assisting 3D Printed Elbow Prosthesis for Open Elbow Fracture with Severe Bone Defect: A Case Report and Technique Note. Orthop Surg 2022; 14:3423-3430. [PMID: 36263967 PMCID: PMC9732626 DOI: 10.1111/os.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 05/28/2022] [Accepted: 08/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Internal fixation for severe open articular bone defects is sometimes ineffective or dangerous. In the emergency stage, radical debridement and infection prevention are demanded to provide a good tissue base and the space-occupying effect to provide enough necessary space to avoid soft-tissue contraction for the reconstruction. In addition, the 3D printing technology makes individual limb reconstruction a reality. CASE PRESENTATION Here, we present a 31-year-old patient with an open fracture and severe bone defect of his left elbow caused by traffic accident, classified as Gustilo-Anderson IIIB. We adopted aggressive debridement and insertion of polymethyl methacrylate (PMMA) to prevent the infection and temporarily construct the bone defect in the emergency stage. Secondly, the total elbow arthroplasty was performed using a unique three-dimensional (3D) printed prosthesis to reconstruct the elbow joint. During the follow-up, the elbow movement function was satisfactory. CONCLUSIONS The modified Masquelet technique assisting 3D printing of personalized elbow joint makes the satisfactory functional reconstruction for open high-energy injuries come true. It could be promoted for the similar surgery of other open joints fractures with severe bone defects.
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Affiliation(s)
- Chunquan Zhu
- Department of Trauma and Microsurgery OrthopedicsZhongnan Hospital of Wuhan UniversityWuhanChina,Department of OrthopedicsWuhan Fourth HospitalPuai HospitalWuhanChina
| | - Chong Zhang
- Department of Trauma and Microsurgery OrthopedicsZhongnan Hospital of Wuhan UniversityWuhanChina
| | - Yong Zhao
- Department of Trauma and Microsurgery OrthopedicsZhongnan Hospital of Wuhan UniversityWuhanChina
| | - Guorong Yu
- Department of Trauma and Microsurgery OrthopedicsZhongnan Hospital of Wuhan UniversityWuhanChina
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Grisdela P, Striano B, Shapira S, Heng M. Does distance from joint line influence complications after distal femur fractures in native and periprosthetic knees? Knee 2022; 37:80-86. [PMID: 35700587 DOI: 10.1016/j.knee.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/23/2022] [Accepted: 05/28/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Distal femur fractures are projected to increase in incidence secondary to an aging population and growing utilization of total knee arthroplasty. Surgical management is the standard of care, but optimal treatment for far distal fractures is still unclear. Our study investigates if there are distal femur fractures too distal to be treated with lateral locked plating in periprosthetic fractures. METHODS One hundred and ten consecutive patients treated with locked plating for distal femur fractures around a total knee replacement were identified using CPT codes. Fractures were classified by length of the distal fracture segment and Su classification. Complications studied were nonunion, malunion, infection, further fracture related surgery, readmission within 90 days, and mortality within 1 year of surgery. Sixty six fractures met inclusion criteria of 180 days of follow-up or sustaining a complication prior to180 days. RESULTS The size of the distal fracture segment and Su classification did not correlate with increased complication rate in periprosthetic distal femur fractures. CONCLUSIONS There was no difference between complications following lateral locked plating of distal femur fractures based on the size of the distal fracture segment in periprosthetic fractures. Lateral locked plating is an effective treatment modality for these fractures regardless of how distal the fracture extends.
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Affiliation(s)
- Phillip Grisdela
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA.
| | - Brendan Striano
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA.
| | - Shay Shapira
- Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel; Harvard Medical School Orthopaedic Trauma Initiative, Boston MA, USA.
| | - Marilyn Heng
- Harvard Medical School Orthopaedic Trauma Initiative, Boston MA, USA; Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, MA, USA.
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Practical approach to the native distal femur fractures in the elderly: A rapid review over the recent trends. Injury 2022; 53:2389-2394. [PMID: 35644641 DOI: 10.1016/j.injury.2022.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
Significant work has been done in recent years on treatment strategies for distal femur fractures. Inclusive reviews on periprosthetic fractures of distal femur have been carried out recently, but there is a lack of such reviews on the subject of native distal femur fractures in the recent literature. In this narrative review, we are set out to address the latest updates on geriatric non-periprosthetic distal femur fractures, and perform a rapid review over different treatment options, arriving at a summarized proposed treatment algorithm.
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Aebischer AS, Hau R, de Steiger RN, Holder C, Wall CJ. Distal femoral arthroplasty for native knee fractures : results from the Australian Orthopaedic Association National Joint Replacement Registry. Bone Joint J 2022; 104-B:894-901. [PMID: 35775178 DOI: 10.1302/0301-620x.104b7.bjj-2021-1136.r3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS The aim of this study was to investigate the rate of revision for distal femoral arthroplasty (DFA) performed as a primary procedure for native knee fractures using data from the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR). METHODS Data from the AOANJRR were obtained for DFA performed as primary procedures for native knee fractures from 1 September 1999 to 31 December 2020. Pathological fractures and revision for failed internal fixation were excluded. The five prostheses identified were the Global Modular Arthroplasty System, the Modular Arthroplasty System, the Modular Universal Tumour And Revision System, the Orthopaedic Salvage System, and the Segmental System. Patient demographic data (age, sex, and American Society of Anesthesiologists grade) were obtained, where available. Kaplan-Meier estimates of survival were used to determine the rate of revision, and the reasons for revision and mortality data were examined. RESULTS The AOANJRR identified 153 primary DFAs performed for native knee fractures in 151 patients during the study period, with 63.3% of these (n = 97) performed within the last five years. The median follow-up was 2.1 years (interquartile range 0.8 to 4.4). The patient population was 84.8% female (n = 128), with a mean age of 76.1 years (SD 11.9). The cumulative percent revision rate at three years was 10%. The most common reason for revision was loosening, followed by infection. Patient survival at one year was 87.5%, decreasing to 72.8% at three years postoperatively. CONCLUSION The use of DFA to treat native knee fractures is increasing, with 63.3% of cases performed within the last five years. While long-term data are not available, the results of this study suggest that DFA may be a reasonable option for elderly patients with native knee fractures where fixation is not feasible, or for whom prolonged non-weightbearing may be detrimental. Cite this article: Bone Joint J 2022;104-B(7):894-901.
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Affiliation(s)
| | - Raphael Hau
- Eastern Health Clinical School, Monash University, Melbourne, Australia.,Department of Surgery, University of Melbourne, Northern Medical School, Melbourne, Australia
| | - Richard N de Steiger
- Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Australia.,Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
| | - Carl Holder
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Christopher J Wall
- Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Australia.,School of Medicine Rural Clinical School, University of Queensland, Toowoomba, Australia
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Barzen S, Buschbeck S, Hoffmann R. [Distal femoral fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:507-517. [PMID: 35725933 DOI: 10.1007/s00113-022-01197-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
CLINICAL ISSUE Fractures of the distal femur represent rare but serious injuries with a high 1‑year mortality. An increasingly older patient population requires adapted treatment concepts. STANDARD TREATMENT PROCEDURE Surgical treatment using angular stable plating and retrograde nailing is the standard procedure. Conservative treatment is only indicated in cases of low demands and high perioperative risks of the patient. TREATMENT INNOVATIONS Primary double plate osteosynthesis and primary implantation of a distal femoral replacement represent new treatment procedures and show promising initial results in the collective of geriatric patients. DIAGNOSTIC WORK-UP Conventional radiographs in 2 planes and computed tomography with multiplanar and 3D reconstructions should be performed to enable an adequate assessment of the indications and treatment planning. PERFORMANCE Nonunion rates of plate and nail osteosyntheses range from 4% to 10%. No significant differences in long-term results can be observed. The results regarding double plate osteosynthesis and distal femoral replacement so far do not show any disadvantages compared to the existing procedures but there is still insufficient data for general recommendations. ASSESSMENT Complex fractures with extensive reconstructive procedures and treatment by distal femoral replacement should be performed in specialized centers. PRACTICAL RECOMMENDATIONS The gold standard is still surgical treatment by means of minimally invasive angular stable plate or retrograde nail osteosynthesis. Complex fracture forms require individual treatment planning considering all currently available treatment options.
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Affiliation(s)
- S Barzen
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Unfallchirurgie und orthopädische Chirurgie, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland.
| | - S Buschbeck
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Unfallchirurgie und orthopädische Chirurgie, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland
| | - R Hoffmann
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Unfallchirurgie und orthopädische Chirurgie, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland
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Zanchini F, Piscopo A, Cipolloni V, Fusini F, Cacciapuoti S, Piscopo D, Pripp C, Nasto LA, Pola E. Distal femur complex fractures in elderly patients treated with megaprosthesis: Results in a case series of 11 patients. World J Orthop 2022; 13:454-464. [PMID: 35633750 PMCID: PMC9124994 DOI: 10.5312/wjo.v13.i5.454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/19/2022] [Accepted: 04/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial. Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for early walking and rapid restoration of function and also pose significant obstacles to achievement of satisfactory results with standard fixation techniques. Recently, several authors have suggested that primary arthroplasty could be a viable alternative option to standard fixation techniques in selected patients with complex distal femur fractures. AIM To present our experience with 11 cases of distal femur fractures treated with knee arthroplasty and large femoral resection in a population of patients over the age of 85. METHODS Data from 11 consecutive patients (10 females, 1 male) presenting with acute intra-articular supracondylar or intercondylar distal femur fractures and with pre-existent primary osteoarthritis who were treated with primary knee arthroplasty were recorded. We collected standard demographic data, comorbidities and patient reported outcomes including Visual Analogical Scale (VAS), Oxford Knee Score (OKS) and Barthel's Index. Post-operative joint range of motion (ROM) and standard radiographic data were also collected. RESULTS At a mean follow-up of 23.2 mo, all of the implants were well-positioned and osteointegrated. Furthermore, all the patients were alive and walking either independently or with walking aids. There was a marked improvement in pain (VAS 4.5 postop vs 1.9 at the last follow-up), OKS score (29.5 postop vs 36.81 at the last follow-up), ROM (96.2° postop vs 102° at the last follow-up) and restoration of pre-injury ambulatory status (average Barthel Index 77.3). The radiographic evaluations showed good restoration of the articular geometry. No deaths and no complications were recorded. CONCLUSION In conclusion, we believe that knee megaprosthesis in the case of complex fractures of the distal femur is a valid surgical choice. This is particularly true in elderly patients with severe osteoporosis and pre-existing osteoarthritis. It is important to note that this surgery should be performed by surgeons with proven experience in prosthetic hip and knee surgery and that a scrupulous selection of the cases is completed.
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Affiliation(s)
- Fabio Zanchini
- Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Naples 80138, Italy
| | - Antonio Piscopo
- Department of Orthopedics and Traumatology, Sacro Cuore di Gesù Fatebenefratelli Hospital, Benevento 82100, Italy
| | - Valerio Cipolloni
- Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli IRCCS University Hospital, Catholic University of Rome, Rome 00168, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Mondovì 12084, Italy
| | - Stefano Cacciapuoti
- Department of Orthopedics and Traumatology, Sacro Cuore di Gesù Fatebenefratelli Hospital, Benevento 82100, Italy
| | - Davide Piscopo
- Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Naples 80138, Italy
| | - Charlotte Pripp
- Service de Geriatrie et réaaptation HUG, Hôpital de Bellerive Chem, Genève 1205, Switzerland
| | - Luigi Aurelio Nasto
- Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Naples 80138, Italy
| | - Enrico Pola
- Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Naples 80138, Italy
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Clinical Outcomes Following Distal Femur Replacement for Periprosthetic Distal Femur Fractures: A Systematic Review and Meta-Analysis. J Arthroplasty 2022; 37:1002-1008. [PMID: 35093546 DOI: 10.1016/j.arth.2022.01.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Management of periprosthetic distal femur fractures (PDFFs) is often complicated by poor bone quality and limited bone stock making fixation attempts challenging and prone to failure. Distal femoral replacement (DFR) is being used to treat such injuries although outcome data are mostly from small case series. We sought to systematically review the literature on DFR for PDFF to summarize their outcomes. METHODS PubMed, MEDLINE (EBSCO), and Cochrane Central Database were searched to identify reports of PDFFs treated with DFR. Articles reporting on 5 or more knees were systematically reviewed for clinical function, complications, and mortality. Random effects meta-analysis was used to create summary estimates and publication bias also assessed. RESULTS Of 287 identified and screened articles, 15 were included, 14 retrospective, reporting on 352 knees. Following DFR, 87% (95% confidence interval [CI] 71-95) of patients were able to ambulate. The mean postoperative Knee Society Score was 80 (95% CI 77-84). The risk of periprosthetic joint infection was 4.3% (95% CI 2.2-8.2). One-year postoperative mortality rate was 10% (95% CI 6-18). There was some evidence of publication bias with a trend toward smaller studies reporting lower infection risk and mortality. CONCLUSION DFR for PDFFs is associated with high functional outcomes and a relatively modest risk of infection. The periprosthetic joint infection and 1-year mortality rates reported here should be considered lower bounds estimates due to publication bias and loss to follow-up. Further investigation of long-term outcomes following DFR for PDFFs is warranted though short-term functional outcomes are promising.
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Joshi N, Pujol O, Prat S. Complex distal femoral fractures in the fragile elderly patient treated by distal femoral replacement: A report of three cases. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:149-153. [DOI: 10.1016/j.recot.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/22/2021] [Accepted: 07/18/2021] [Indexed: 10/19/2022] Open
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Joshi N, Pujol O, Prat S. [Artículo traducido] Fractura de fémur distal compleja en el paciente frágil y anciano tratada mediante reemplazo femoral distal: reporte de 3 casos. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T149-T153. [DOI: 10.1016/j.recot.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/18/2021] [Indexed: 10/19/2022] Open
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Antao NA, Londhe S, Toor R, Shirishkar R, Aiyer S. Short-term results of a novel management of supracondylar fracture with coexisting osteoarthritis with bifold fixation and total knee arthroplasty. ARTHROPLASTY 2021; 3:44. [PMID: 35236499 PMCID: PMC8796440 DOI: 10.1186/s42836-021-00098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Presence of supracondylar and periarticular femoral fracture with associated arthritis of knee poses a challenging situation to the orthopaedic surgeon. The results of fixation of fracture in osteoporosis are not very satisfactory and have complications. With fixation alone, they still cannot bear weight on affected leg due to severe disability of osteoarthritis. To make patient walk, conventionally three surgeries in the form of fracture fixation, removal of implant and total knee arthroplasty (TKA) needs to be done in staged manner. We propose a novel management in form of bifold fixation and simultaneous TKA. METHODS Eight cases (6 females, 2 males) of supracondylar femoral fractures with severe osteoarthritis of the knee and osteoporosis were primarily fixed with bifold fixation using SIGN nail ( www.signfracturecare.org ) and locking plate together with simultaneous total knee arthroplasty. There were five cases (2 males and 3 females) of grade 4 (Kellgren-Lawrence grading) osteoarthritis (OA) and three cases (all females) of severe rheumatoid arthritis (RA). RESULTS The mean age was 68 years and average time for full weight bearing was 6 days. Radiographic evidence of fracture union was achieved in 16.25 weeks. The mean Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 26 months was 83.13 and 22.13 respectively. CONCLUSIONS Single stage combined bifold osteosynthesis with interlocking nail and locking plate together with total knee arthroplasty helps in one time management of these difficult injuries. It is a cost-effective and economically sound option and gives excellent results with good patient satisfaction.
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Affiliation(s)
- Nicholas A Antao
- Department of Orthopaedics Holy Spirit Hospital, Jeevan Data Hostel, Mahakali Caves Road, Andheri (E), Mumbai, Maharashtra, 400093, India
| | - Sanjay Londhe
- Department of Orthopaedics Holy Spirit Hospital, Jeevan Data Hostel, Mahakali Caves Road, Andheri (E), Mumbai, Maharashtra, 400093, India
| | - Rajan Toor
- Department of Orthopaedics Holy Spirit Hospital, Jeevan Data Hostel, Mahakali Caves Road, Andheri (E), Mumbai, Maharashtra, 400093, India.
| | - Rajesh Shirishkar
- Department of Orthopaedics Holy Spirit Hospital, Jeevan Data Hostel, Mahakali Caves Road, Andheri (E), Mumbai, Maharashtra, 400093, India
| | - Siddharth Aiyer
- Indian Orthopaedic Research Group, Thane, Maharashtra, 400604, India
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Onubogu IK, Relwani S, Grewal US, Bhamra JS, Reddy KG, Dhinsa BS. Distal Femoral Replacement as a Primary Treatment Method for Distal Femoral Fractures in the Elderly. Cureus 2021; 13:e18752. [PMID: 34790497 PMCID: PMC8589001 DOI: 10.7759/cureus.18752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/05/2022] Open
Abstract
Distal femoral fractures account for 3-6% of all femoral fractures with a similar demographic as patients suffering from proximal femoral fractures. The mortality risk can be high in such injuries, which has prompted NHS England to extend the scope of the Best Practice Tariff to include all fragility fractures of the femur. Poor bone quality, intra-articular extension, and significant comminution can make these fractures difficult to manage with fixation techniques, while early mobilisation is a key outcome in the treatment of this injury. In this study, a comprehensive literature search was performed based on keywords, and abstracts were reviewed to identify relevant articles. The following factors were analysed: time to surgery, time to full weight-bearing, the average hospital stay, post-operative mobility status, and complications. A total of 233 abstracts were identified using the pre-determined search criteria, and, subsequently, articles were excluded following author review. A total of 10 relevant articles were included in this review, with five used for review and comparison between distal femoral replacement (DFR) and fixation. This resulted in a sample of 200 patients treated with DFR with over 87% ambulatory at follow-up and a re-operation rate of 13.3% compared to 78% and 13.5%, respectively, in those treated with open reduction internal fixation (ORIF) procedure. Despite a limited pool of evidence, the literature suggests that DFR offers an option that potentially allows immediate weight-bearing and leaves most patients ambulatory at follow-up. Although DFR is more costly than other operative techniques, it avoids complications associated with fixation such as non-union and can reduce the risk of further surgery through direct complications or a need for delayed arthroplasty, which is deemed more complex secondary to fixation. Early mobilisation is a key step in reducing morbidity and mortality among this cohort of patients, and a procedure such as DFR should be more widely considered to help achieve this outcome.
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Affiliation(s)
| | - Sanjana Relwani
- Trauma and Orthopaedics, Barts and The London School of Medicine and Dentistry, London, GBR
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Bourbotte-Salmon F, Ferry T, Cardinale M, Servien E, Rongieras F, Fessy MH, Bertani A, Laurent F, Buffe-Lidove M, Batailler C, Lustig S, The Lyon Bone and Joint Infections Study Group. Rotating Hinge Knee Arthroplasty for Revision Prosthetic-Knee Infection: Good Functional Outcomes but a Crucial Need for Superinfection Prevention. Front Surg 2021; 8:551814. [PMID: 34616767 PMCID: PMC8488173 DOI: 10.3389/fsurg.2021.551814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Management of chronic infection following total knee arthroplasty (TKA) is challenging. Rotating hinged prostheses are often required in this setting due to severe bone loss, ligamentous insufficiency, or a combination of the two. The nature of the mechanical and septic complications occurring in this setting has not been well-described. The aim of this study was to evaluate patient outcomes using a hinge knee prosthesis for prosthetic knee infections and to investigate risk factors for implant removal. Methods: This was a retrospective cohort study that included all patients treated in our tertiary level referral center between January 2009 and December 2016 for prosthetic knee infection with a hinge knee prosthesis. Only patients with a minimum 2-year of follow-up were included. Functional evaluation was performed using international knee society (IKS) "Knee" and "Function" scores. Survival analysis comparing implant removal risks for mechanical and septic causes was performed using Cox univariate analysis and Kaplan-Meier curves. Risk factors for implant removal and septic failure were assessed. Results: Forty-six knees were eligible for inclusion. The majority of patients had satisfactory functional outcomes as determined by mean IKS scores (mean knee score: 70.53, mean function score: 46.53 points, and mean knee flexion: 88.75°). The 2-year implant survival rate was 89% but dropped to 65% at 7 years follow-up. The risk of failure (i.e., implant removal) was higher for septic etiology compared to mechanical causes. Patients with American society of anesthesiologists (ASA) score>1, immunosuppression, or with peripheral arterial diseases had a higher risk for septic failure. Patients with acute infection according to the Tsukayamaclassification had a higher risk of failure. Of the 46 patients included, 19 (41.3%) had atleast one infectious event on the surgical knee and most of these were superinfections (14/19) with new pathogens isolated. Among pathogens responsible for superinfections (i) cefazolin and gentamicin were both active in six of the cases but failed to prevent the superinfection; (ii) cefazolin and/or gentamicin were not active in eight patients, leading to alternative systemic and/or local antimicrobial prophylaxis consideration. Conclusions: Patients with chronic total knee arthroplasty (TKA) infection, requiring revision using rotating hinge implant, had good functional outcomes but experienced a high rate of septic failure, mostly due to bacterial superinfection. These patients may need optimal antimicrobial systemic prophylaxis and innovative approaches to reduce the rate of superinfection.
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Affiliation(s)
| | - Tristan Ferry
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- CIRI – Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Mickaël Cardinale
- Department of Anesthesiology and Intensive Care, Hôpital d'Instruction des Armées Saint-Anne, Toulon, France
| | - Elvire Servien
- Université Claude Bernard Lyon 1, Lyon, France
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Department of Orthopaedic and Sport Surgery, Hôpital de la Croix Rousse, Lyon, France
| | - Frédéric Rongieras
- Department of Orthopaedic and Traumatologic Surgery, Hôpital Edouard Herriot, Lyon, France
| | - Michel-Henry Fessy
- Université Claude Bernard Lyon 1, Lyon, France
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Department of Orthopaedic and Traumatologic surgery, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Antoine Bertani
- Department of Orthopaedic and Traumatologic Surgery, Hôpital Edouard Herriot, Lyon, France
| | - Frédéric Laurent
- Université Claude Bernard Lyon 1, Lyon, France
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Institut des Agents Infectieux, Hôpital de la Croix Rousse, Lyon, France
| | - Margaux Buffe-Lidove
- Department of Physical and Rehabilitation Medicine, Hôpital d'Instruction des Armées Desgenettes, Lyon, France
| | - Cécile Batailler
- Université Claude Bernard Lyon 1, Lyon, France
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Department of Orthopaedic and Sport Surgery, Hôpital de la Croix Rousse, Lyon, France
| | - Sébastien Lustig
- Université Claude Bernard Lyon 1, Lyon, France
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Department of Orthopaedic and Sport Surgery, Hôpital de la Croix Rousse, Lyon, France
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Tibbo ME, Parry JA, Hevesi M, Abdel MP, Yuan BJ. Distal femoral replacement versus ORIF for severely comminuted distal femur fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:959-964. [PMID: 34196820 DOI: 10.1007/s00590-021-03061-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Distal femoral replacement (DFR) and open reduction and internal fixation (ORIF) are surgical options for comminuted distal femur fractures. Comparative outcomes of these techniques are limited. The aims of this study were to compare implant survivorship, perioperative factors, and clinical outcomes of DFR vs. ORIF for comminuted distal femur fractures. METHODS Ten patients treated with rotating hinge DFRs for AO/OTA 33-C fractures from 2005 to 2015 were identified and matched 1:2 based on age and sex to 20 ORIF patients. Patients treated with DFR and ORIF had similar ages (80 vs. 76 years, p = 0.2) and follow-up (20 vs. 27 months, p = 1.0), respectively. Implant survivorship, length of stay (LOS), anesthetic time, estimated blood loss (EBL), ambulatory status, knee range of motion (ROM), and Knee Society scores (KSS) were assessed at final follow-up. RESULTS Survivorship free from any revision at 2 years was 90% and 65% for the DFR and ORIF groups, respectively (p = 0.59). Survivorship free from any reoperation at 2 years was 90% for the DFR group and 50% for the ORIF group (p = 0.16). Three ORIF patients (15%) went on to nonunion and two went on to delayed union. Mean EBL and LOS were significantly higher for the DFR group: 592 mL vs. 364 mL, and 13 vs. 6.5 days, respectively. Knee ROM (p = 0.71) and KSSs (p = 0.36) were similar between groups. CONCLUSIONS Comminuted distal femur fractures treated with DFR trended toward lower revision and reoperation rates, with similar functional outcomes when compared to ORIF. We noted a trend toward increased EBL and LOS in the DFR group. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Meagan E Tibbo
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA
| | - Joshua A Parry
- Department of Orthopaedic Surgery, University of Colorado, 777 Bannock St, Denver, CO, 80204, USA
| | - Mario Hevesi
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA
| | - Matthew P Abdel
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA
| | - Brandon J Yuan
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA.
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Hoedt CW, Kellish AS, Frisby JC, Rivera-Pintado C, Kim TW, Gutowski CJ. Hospital Resource Utilization Associated With Endoprosthetic Reconstruction Versus Primary Arthroplasty. Orthopedics 2021; 44:e73-e79. [PMID: 33141230 DOI: 10.3928/01477447-20201012-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/06/2019] [Indexed: 02/03/2023]
Abstract
Endoprosthetic reconstructions of the hip and knee are currently reimbursed as primary hip and knee arthroplasty according to Current Procedural Terminology (CPT) coding guidelines. The purpose of this study was to compare hospital resources consumed by patients undergoing endoprosthetic reconstruction with those consumed by patients undergoing primary arthroplasty. The authors' hypothesis was that the former group carries more comorbidities, experiences longer length of stay (LOS), and has greater resource consumption. A retrospective review was performed of 61 patients undergoing endoprosthetic reconstruction and 745 patients undergoing primary hip or knee arthroplasty between 2015 and 2018 at a single institution. Demographic, clinical, and financial data were compared. The Charlson Comorbidity Index (CCI) was used to measure patients' health status and identify comorbidities associated with prolonged LOS through linear regression analysis. Patients who underwent endoprosthetic reconstruction had a greater than 3.5 times average LOS compared with primary arthroplasty patients: 10.81 days vs 2.94 days (P<.01). They demonstrated a higher mean CCI, higher rates of malignancy and pulmonary disease, and a wider age range. Their mean cost of care totaled $73,730.29, compared with $24,940.84 imposed by primary arthroplasty patients (P<.01). Significant predictors of LOS were malignancy status (metastatic or localized) and age younger than 50 years, with increased LOS being associated with increased cost. Patients undergoing endoprosthetic reconstruction of the hip and knee represent a fundamentally different patient population than primary arthroplasty patients based on comorbidities, variability in health status, and surgical indications. They have higher comorbidity scores and longer hospitalizations and consume more financial resources than primary arthroplasty patients. [Orthopedics. 2021;44(1):e73-e79.].
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Distal Femur Replacement Versus Surgical Fixation for the Treatment of Geriatric Distal Femur Fractures: A Systematic Review. J Orthop Trauma 2021; 35:2-9. [PMID: 32569072 DOI: 10.1097/bot.0000000000001867] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The management of geriatric distal femur fractures is controversial, and both primary distal femur replacement (DFR) and surgical fixation (SF) are viable treatment options. The purpose of this study was to compare patient outcomes after these treatment strategies. DATA SOURCES PubMed, Embase, and Cochrane databases were searched for English language articles up to April 24, 2020, identifying 2129 papers. STUDY SELECTION Studies evaluating complications in elderly patients treated for distal femur fractures with either immediate DFR or SF were included. Studies with mean patient age <55 years, nontraumatic indications for DFR, or SF with nonlocking plates were excluded. DATA EXTRACTION Two studies provided Level II or III evidence, whereas the remaining 28 studies provided Level IV evidence. Studies were formally evaluated for methodological quality using established criteria. Treatment failure between groups was compared using an incidence rate ratio. DATA SYNTHESIS Treatment failure was defined for both SF and arthroplasty as complications requiring a major reoperation for reasons such as mechanical failure, nonunion, deep infection, aseptic loosening, or extensor mechanism disruption. There were no significant differences in complication rates or knee range of motion between SF and DFR. CONCLUSIONS SF and DFR for the treatment of geriatric distal femur fractures demonstrate similar overall complication rates. Given the available evidence, no strong conclusions on the comparative effectiveness between the 2 treatments can be definitively made. More rigorous prospective research comparing SF vs. DFR to treat acute geriatric distal femur fractures is warranted. LEVEL OF EVIDENCE Therapeutic Level IV. See instructions for authors for a complete description of levels of evidence.
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Tampere T, Ollivier M, Jacquet C, Fabre-Aubrespy M, Parratte S. Knee arthroplasty for acute fractures around the knee. EFORT Open Rev 2020; 5:713-723. [PMID: 33204515 PMCID: PMC7608576 DOI: 10.1302/2058-5241.5.190059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Results of open reduction and internal fixation for complex articular fractures around the knee are poor, particularly in elderly osteoporotic patients. Open reduction and internal fixation may lead to an extended hospital stay and non-weight-bearing period. This may lead to occurrence of complications related to decubitus such as thrombo-embolic events, pneumonia and disorientation. Primary arthroplasty can be a valuable option in a case-based and patient-specific approach. It may reduce the number of procedures and allow early full weight-bearing, avoiding the above-mentioned complications. There are four main indications:
1) Elderly (osteoporotic) patients with pre-existing (symptomatic) end-stage osteoarthritis. 2) Elderly (osteoporotic) patients with severe articular and metaphyseal destruction. 3) Pathological fractures of the distal femur and/or tibia. 4) Young patients with complete destruction of the distal femur and/or tibia. The principles of knee (revision) arthroplasty should be applied; choice of implant and level of constraint should be considered depending on the type of fracture and involvement of stabilizing ligaments. The aim of treatment is to obtain a stable and functional joint. Long-term data remain scarce in the literature due to limited indications. Cite this article: EFORT Open Rev 2020;5:713-723. DOI: 10.1302/2058-5241.5.190059
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Affiliation(s)
- Thomas Tampere
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Matthieu Ollivier
- Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France
| | - Christophe Jacquet
- Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France
| | - Maxime Fabre-Aubrespy
- Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France
| | - Sébastien Parratte
- Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France.,Department of Orthopaedic Surgery, International Knee and Joint Centre, Abu Dhabi, UAE
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Wui NB, Ahmad Anuar MA, Abdul Wahid AM. Short-Term Outcome of Early Primary Total Knee Arthroplasty for Fractures Around the Knee in the Elderly Population: The Experience of a Secondary Healthcare Centre in Malaysia. Malays J Med Sci 2020; 27:64-71. [PMID: 32863746 PMCID: PMC7444830 DOI: 10.21315/mjms2020.27.4.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023] Open
Abstract
Background The management of fractures around the knee in the elderly population can be challenging due to the complexity of the patients and the fracture characteristics. In this study, we aimed to investigate the short-term outcome of elderly patients who had fractures around the knee and who were treated with primary total knee arthroplasty. The study included patients who were at least 70 years old with poor bone quality and who presented with a fracture around the knee that would be difficult to treat with open reduction and internal fixation (ORIF) as well as patients who were at least 55 years old presenting with severe concomitant knee osteoarthritis. Methods This is a cross-sectional study in which all the elderly patients who underwent early primary total knee replacement due to trauma around the knee at the Segamat Hospital between January 2015 and June 2019 were identified. Data were collected from clinical and operative notes. The clinical outcomes of these patients were evaluated by the range of motion of the knee and the Knee Society Score (KSS). Results Ten patients were identified to have undergone this procedure. Six patients sustained supracondylar femur fractures, two patients had tibial plateau fractures and two patients had concurrent supracondylar femur and tibial plateau fractures. The mean follow-up duration was 22.3 ± 13.9 months, the mean knee score was 87.7 ± 10.0 and the mean functional knee score was 56 ± 41.9. Conclusion In this cohort, good short-term outcomes close to pre-fracture condition was noted in patients who did not suffer from any complications during the post-operative period. Two patients who had surgical site infection had lower functional knee scores. Another two patients with lower knee scores experienced surgical site infection of the distal tibia and contralateral fixed flexion deformity of the knee. Early primary total knee replacement remains a viable option in treating fractures around the knee in the elderly. Infection, which in this study affected 20% of the patients, is the main deterring factor in performing this procedure.
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Affiliation(s)
- Ng Bing Wui
- Orthopaedic Department, Hospital Segamat, Ministry of Health Malaysia, Johor, Malaysia
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Kouyoumdjian P, Coulomb R, d'Ambrosio A, Ravoyard S, Cavaignac E, Pasquier G, Ehlinger M. Hinged total knee arthroplasty for fracture cases: Retrospective study of 52 patients with a mean follow-up of 5 years. Orthop Traumatol Surg Res 2020; 106:389-395. [PMID: 32265171 DOI: 10.1016/j.otsr.2019.11.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 11/01/2019] [Accepted: 11/07/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Hinged total knee arthroplasty (hTKA) is one of the treatment options available for complex fractures around an intact knee or an existing implant. The primary objective of this multicenter study was to evaluate the medium-term outcomes of hTKA for fractures. The secondary objective was to analyze the complications and risk factors based on fracture type, predisposition and time to surgery. We hypothesized that outcomes would be satisfactory, despite the context, and comparable to published data although impacted by significant mortality and morbidity. MATERIALS AND METHODS Within the framework of a symposium organized by the French Society of Orthopedic and Traumatology Surgery (SOFCOT), 52 patients from 11 hospitals were included retrospectively. All had undergone hTKA following a fracture event: recent fracture, postoperative course after a complex epiphyseal fracture on an intact knee, or periprosthetic fracture. Clinical outcomes (demographics, IKS score, Parker score, Devane score, time to surgery) and radiographic outcomes, along with complications were analyzed. RESULTS Of the 52 patients included, 3 were lost to follow-up and 1 died early on. Thus, 48 patients with a mean age of 72 years (range, 31-95) were available for analysis at a mean follow-up of 59 months (range, 3-162). Forty of these patients (78%) had suffered a fracture to an intact knee and 12 (22%) had suffered a periprosthetic fracture. Of the 52 initial patients, 21 (40%) had early complications with 7 patients (19%) requiring surgical revision (5 surgical site infections, 1 extensor mechanism tear, 1 patellar dislocation). Sixteen patients (31%) developed late complications an average of 57 months after the hTKA implantation. All required surgical revision. There were 8 implant infections (15%), 3 cases of stiffness (6%), 2 extensor mechanism tears (4%) and 3 cases of loosening (6%). At a mean follow-up of 59 months, there was a 24-point improvement on the IKS pain scale (p=0.032). The postoperative activity level was unchanged in the patients who did not suffer a complication. The mortality rate was high (7/48; 15%). CONCLUSION Our hypothesis was confirmed since the outcomes were satisfactory, but mortality and morbidity were high. Performing hTKA remains an option in the post-fracture context, although surgeons must carefully consider the indications. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Pascal Kouyoumdjian
- Service de chirurgie orthopédique et traumatologie, Chirurgie du rachis, CHRU de Nîmes, CHU Nîmes, 4, rue du Professeur Robert-Debré, 30029 Nîmes, France.
| | - Rémy Coulomb
- Service de chirurgie orthopédique et traumatologie, Chirurgie du rachis, CHRU de Nîmes, CHU Nîmes, 4, rue du Professeur Robert-Debré, 30029 Nîmes, France
| | - Adrien d'Ambrosio
- Service de chirurgie orthopédique et de traumatologie, Hôpital de Hautepierre, CHU Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - Salomé Ravoyard
- Service de chirurgie orthopédique et traumatologie, Chirurgie du rachis, CHRU de Nîmes, CHU Nîmes, 4, rue du Professeur Robert-Debré, 30029 Nîmes, France
| | - Etienne Cavaignac
- Service de chirurgie orthopédique et traumatologie, CHU Toulouse, Hôpital Pierre-Paul Riquet, place du Docteur Baylac - TSA 40031, 31059 Toulouse, France
| | - Gilles Pasquier
- Service orthopédie D, CHRU de Lille, Cite hospitalière, 2, avenue Oscar Lambret, 59000 Lille, France
| | - Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie, Hôpital de Hautepierre, CHU Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
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- 56, rue Boissonade, 75014 Paris, France
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Rice OM, Springer BD, Karunakar MA. Acute Distal Femoral Replacement for Fractures About the Knee in the Elderly. Orthop Clin North Am 2020; 51:27-36. [PMID: 31739877 DOI: 10.1016/j.ocl.2019.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Distal femoral replacement (DFR) is a reasonable treatment option when used for select indications. In the setting of comminuted intra-articular distal femoral fractures, distal femoral arthroplasty should be considered in low-demand patients with poor bone quality. This article summarizes the existing literature plus the authors' personal experience with DFR use for distal femoral fractures of the native knee.
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Affiliation(s)
- Olivia M Rice
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Bryan D Springer
- OrthoCarolina Hip and Knee Center, Atrium Health Musculoskeletal Institute, 2001 Vail Avenue Suite 200A, Charlotte, NC 28207, USA
| | - Madhav A Karunakar
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA.
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Tandon T, Tadros BJ, Avasthi A, Hill R, Rao M. Management of periprosthetic distal femur fractures using distal femoral arthroplasty and fixation - Comparative study of outcomes and costs. J Clin Orthop Trauma 2020; 11:160-164. [PMID: 32002006 PMCID: PMC6985021 DOI: 10.1016/j.jcot.2019.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 03/21/2019] [Accepted: 05/21/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Our study compares the outcome and cost of distal femoral arthroplasty to that of Fixation (Plating/Retrograde Nailing) in the management of distal femur peri-prosthetic fractures. METHODS We reviewed our database for patients admitted with peri-prosthetic distal femoral fractures between 2005 and 2013 (n = 61). The patients were stratified into 2 groups based on management method. The Distal Femoral Arthroplasty group (Group A) had 21 patients and the Fixation group (Group B) had 40 patients. Outcome & cost were compared. Minimum follow-up was 3 years. RESULTS The mean length of stay in group A was 9 days whereas in group B was 32 days. All patients were fully weight bearing by day 3 in group A, compared to a mean of 11 weeks in group B. Mean OKS was 28 and KSS score was 70 in group A compared to 27 and 68 in group B. In group A, there were 2 deaths, 1 superficial infection, and 1 DVT. In group B, there were 6 deaths, 1 failure of fixation, 6 mal-unions, 1 non-union and 2 infections. Overall, the distal femoral arthroplasty procedure costs approximately £9600 and the fixation group costs were on average of £9800. CONCLUSION Distal femoral arthroplasty appears to provide good clinical results, with comparable overall costs to fixation.
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Affiliation(s)
| | - Baha John Tadros
- Corresponding author. Flat 1 23 Cornfield Terrace, St Leonards-on-Sea, TN37 6JD, UK.
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Hull PD, Chou DTS, Lewis S, Carrothers AD, Queally JM, Allison A, Barton G, Costa ML. Knee Fix or Replace Trial (KFORT): a randomized controlled feasibility study. Bone Joint J 2019; 101-B:1408-1415. [PMID: 31674250 DOI: 10.1302/0301-620x.101b11.bjj-2019-0370.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to assess the feasibility of conducting a full-scale, appropriately powered, randomized controlled trial (RCT) comparing internal fracture fixation and distal femoral replacement (DFR) for distal femoral fractures in older patients. PATIENTS AND METHODS Seven centres recruited patients into the study. Patients were eligible if they were greater than 65 years of age with a distal femoral fracture, and if the surgeon felt that they were suitable for either form of treatment. Outcome measures included the patients' willingness to participate, clinicians' willingness to recruit, rates of loss to follow-up, the ability to capture data, estimates of standard deviation to inform the sample size calculation, and the main determinants of cost. The primary clinical outcome measure was the EuroQol five-dimensional index (EQ-5D) at six months following injury. RESULTS Of 36 patients who met the inclusion criteria, five declined to participate and eight were not recruited, leaving 23 patients to be randomized. One patient withdrew before surgery. Of the remaining patients, five (23%) withdrew during the follow-up period and six (26%) died. A 100% response rate was achieved for the EQ-5D at each follow-up point, excluding one missing datapoint at baseline. In the DFR group, the mean cost of the implant outweighed the mean cost of many other items, including theatre time, length of stay, and readmissions. For a powered RCT, a total sample size of 1400 would be required with 234 centres recruiting over three years. At six months, the EQ-5D utility index was lower in the DFR group. CONCLUSION This study found that running a full-scale trial in this country would not be feasible. However, it may be feasible to undertake an international multicentre trial, and our findings provide some guidance about the power of such a study, the numbers required, and some challenges that should be anticipated and addressed. Cite this article: Bone Joint J 2019;101-B:1408-1415.
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Affiliation(s)
- Peter D Hull
- Orthopaedic Trauma Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daud T S Chou
- Orthopaedic Trauma Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sophie Lewis
- Cambridge Biomedical Research Centre, Cambridge, UK
| | - Andrew D Carrothers
- Orthopaedic Trauma Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joseph M Queally
- Orthopaedic Trauma Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Annabel Allison
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gary Barton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Matthew L Costa
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Davis JT, Rudloff MI. Posttraumatic Arthritis After Intra-Articular Distal Femur and Proximal Tibia Fractures. Orthop Clin North Am 2019; 50:445-459. [PMID: 31466661 DOI: 10.1016/j.ocl.2019.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Posttraumatic arthritis (PTA) is a form of joint degeneration that occurs after physical trauma to a synovial joint. Development of PTA is multifactorial and results from mechanical damage at the time of trauma, a cell-mediated inflammatory response, and abnormal articulation due to persistent malalignment or joint instability. Although some risk factors may be unavoidable, preventing the development of PTA of the knee after intra-articular fracture (IAF) requires restoring anatomic articulation and alignment. Reconstruction with total knee arthroplasty is the treatment of choice for PTA and may be a useful primary treatment for IAF in some.
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Affiliation(s)
- Jacob T Davis
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 520, Memphis, TN 38104, USA; Regional One Health Medical Center, 877 Jefferson Avenue, Memphis, TN 38103, USA; The Campbell Foundation, 1211 Union Avenue, Suite 500, Memphis, TN 38104, USA.
| | - Matthew I Rudloff
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 520, Memphis, TN 38104, USA; Regional One Health Medical Center, 877 Jefferson Avenue, Memphis, TN 38103, USA; The Campbell Foundation, 1211 Union Avenue, Suite 500, Memphis, TN 38104, USA
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Abstract
Distal femur fractures occur in a periarticular fracture pattern and disproportionately afflict an aging population. Although the goals of treatment have not changed, the emergence of new surgical techniques and devices has recently been developed and refined to treat this challenging fracture pattern. Treatment options include open reduction and internal fixation with periarticular locking plates, intramedullary nails, or distal femur replacement. Despite rapid adoption, these modern solutions display a concerning complication rate, specifically from nonunion and malunion. The indications for each of these treatment strategies are not well defined and are the subject of current debate. As with the use of any orthopaedic implant, the knowledge of the strengths and weaknesses of each construct is paramount to successful treatment of these fractures. Recently, as the understanding of the biomechanics of distal femur fracture healing has improved, the literature has demonstrated clinical and theoretical improvements in the outcomes after distal femur fracture repair.
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Lau S, Guest C, Annabell L. Evolving indications and reported complications suggest total knee arthroplasty after acute and complex periarticular fractures remains a high-risk operation: a systematic review. J ISAKOS 2019. [DOI: 10.1136/jisakos-2019-000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Neal DC, Sambhariya V, Tran A, Rahman SK, Dean TJ, Wagner RA, Sanchez HB. Single-stage bilateral distal femur replacement for traumatic distal femur fractures. Arthroplast Today 2019; 5:26-31. [PMID: 31020017 PMCID: PMC6470367 DOI: 10.1016/j.artd.2018.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/14/2018] [Accepted: 10/30/2018] [Indexed: 12/04/2022] Open
Abstract
Treatment of periprosthetic distal femur fractures and comminuted intraarticular distal femur fractures with previous arthritis remains a difficult challenge for orthopedic surgeons. Previous case series have shown that distal femur replacement (DFR) can effectively compensate for bone loss, relieve knee pain, and allow for early ambulation in both of these fracture patterns. Owing to the typical low-energy mechanism of these injuries, a bilateral injury treated with DFR is rarely encountered. We present a patient with traumatic open left Rorabeck III/Su III periprosthetic distal femur fracture and closed right intraarticular distal femur fracture (AO fcation 33-C2) with end-stage arthrosis treated with single-stage bilateral DFR. We suggest that in patients with similar injuries, single-stage bilateral DFR can provide the benefits of early mobilization and accelerated recovery.
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Affiliation(s)
- David C Neal
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Varun Sambhariya
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Apollo Tran
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Shawn K Rahman
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Thad J Dean
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Russel A Wagner
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX, USA.,University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Hugo B Sanchez
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX, USA.,University of North Texas Health Science Center, Fort Worth, TX, USA
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Tetsworth K, Woloszyk A, Glatt V. 3D printed titanium cages combined with the Masquelet technique for the reconstruction of segmental femoral defects: Preliminary clinical results and molecular analysis of the biological activity of human-induced membranes. OTA Int 2019; 2:e016. [PMID: 33937652 PMCID: PMC7953522 DOI: 10.1097/oi9.0000000000000016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 09/24/2018] [Indexed: 11/25/2022]
Abstract
Introduction: Traumatic femoral segmental bone loss is a complex clinical problem, one that often requires extreme solutions. This study examines a new treatment strategy for segmental bone loss using patient-specific 3D printed titanium cages in conjunction with the Masquelet technique. Methods: The study was composed of a clinical observational case series, and a basic science investigation to evaluate the biological activity of the induced membranes using histology, immunohistochemistry (IHC), and gene expression analysis. Eligible patients were: adult; post-traumatic; with segmental femoral defects; minimum follow-up 1 year; managed under a 2-stage protocol, with an interim antibiotic poly (methyl methacrylate) (PMMA) spacer. Definitive reconstruction was completed with exchange to a 3D printed custom titanium cage filled with bone graft, and stabilized with either an intramedullary (IM) nail or a lateral locked plate. Results: Patient-specific 3D printed titanium cages were used in 5 consecutive patients to reconstruct post-traumatic segmental femoral defects. The mean interval between stages was 100.2 days (83–119 days), the mean defect length was 14.0 cm (10.3–18.4 cm), and the mean bone defect volume measured 192.4 cc (114–292 cc). The mean length of follow-up was 21.8 months (12–33 months). There were no deep infections, fractures, nerve injuries, loss of alignment, or nonunions identified during the period of follow-up. All of the patients achieved union clinically and radiographically. Histology and IHC demonstrated a greater number of vessels, cell nuclei, and extensive staining for cluster of differentiation 68 (CD68), platelet and endothelial cell adhesion molecule 1 (PECAM-1), and vascular endothelial growth factor (VEGF) in the induced membranes compared to local fascia controls. Gene expression analysis revealed significant differential regulation of essential genes involved in inflammatory, angiogenic, and osteogenic pathways [interleukin 6 (IL-6), nuclear factor kappa B1 (NF-κB1), receptor activator of nuclear factor kappa-β ligand (RANKL), vascular endothelial growth factor A (VEGFA), angiogenin (ANG), transforming growth factor, beta 1 (TGF-β1), bone morphogenetic protein-2 (BMP-2), growth differentiation factor 5 (GDF-5), growth differentiation factor 10 (GDF-10), and runt-related transcription factor 2 (RUNX-2)] in the induced membranes. Conclusions: This study demonstrates that the use of a patient-specific 3D printed custom titanium cage, inserted into an induced membrane in a 2-stage protocol, can achieve very acceptable clinical outcomes in selected cases of post-traumatic femoral segmental defects. Patient-specific 3D printed titanium cages, used in conjunction with the Masquelet technique, are a promising new treatment option for managing complex trauma patients with femoral bone loss. Level of Evidence: Level IV (observational case series).
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Affiliation(s)
- Kevin Tetsworth
- Royal Brisbane and Women's Hospital, Herston, Queensland.,Orthopaedic Research Centre of Australia, Brisbane, Queensland, Australia
| | - Anna Woloszyk
- Department of Orthopedic Surgery, University of Texas Health Science Center San Antonio, Texas
| | - Vaida Glatt
- Orthopaedic Research Centre of Australia, Brisbane, Queensland, Australia.,Department of Orthopedic Surgery, University of Texas Health Science Center San Antonio, Texas
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Total knee arthroplasty for distal femoral fractures in osteoporotic bone: a systematic literature review. Eur J Trauma Emerg Surg 2019; 45:841-848. [PMID: 30820599 DOI: 10.1007/s00068-019-01103-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/25/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE Distal femoral fractures in the elderly are associated with high morbidity and mortality and their incidence is increasing with an ageing population. Management of these fractures has evolved over recent decades and there is now an accepted recognition of the important role that acute arthroplasty may have in treatment of these fractures. Our purpose was to systematically review the evidence available in the literature for arthroplasty as a treatment option for distal femoral fractures. METHODS This systematic review was conducted in accordance with the PRISMA reporting guidelines. We searched CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded (until October 2018) for studies and case series. Furthermore, clinical trial registries were searched for ongoing studies. We included all studies or case series that described total knee arthroplasty for distal femoral fractures irrespective of language, publication status, sample size, or follow-up period due to limited studies available in the literature. Exclusion criteria included single patient case reports, isolated tibia fractures, and periprosthetic fractures. Two authors independently identified trials for inclusion and independently extracted the data. Outcome measures included mortality, peri-operative complications (excluding mortality), anaesthetic time, blood loss, time to mobilisation, length of hospital stay, functional scores, radiological loosening, and revision rate. RESULTS Fourteen papers were included for subsequent quantitative and qualitative synthesis incorporating a total of 181 patients. The highest level of evidence identified was a single cohort study (level III), the remaining 13 papers consisted of multi- or single-centre case series (level IV). The mean mortality rate was 3.34% (range 0-10) at 30 days and 18.4% (range 0-42) at 1 year. The mean revision rate was 3.43% (range 0-25) at 1 year. The mean time to mobilisation was 3.90 days (range 2.5-6) with a mean time to discharge from the acute ward being 16.6 days (range 8-33). CONCLUSIONS Although there is limited evidence in the literature available, our review suggests that there is a role for acute knee arthroplasty in distal femoral fractures. This mode of treatment has satisfactory mortality and revision rates, and may result in faster time to mobilisation and discharge. There is a need for a higher level of evidence to delineate this issue further.
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Anger F, Legré R, Nguyen MK. Results of wrist hemiarthroplasty for comminuted distal radius fractures in independent elderly people: A retrospective study on eleven patients. HAND SURGERY & REHABILITATION 2019; 38:150-156. [PMID: 30711539 DOI: 10.1016/j.hansur.2018.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/29/2018] [Accepted: 11/30/2018] [Indexed: 11/29/2022]
Abstract
The comminuted distal radius fractures among elderly people are usually linked to osteoporosis, and repairing them in this context is a therapeutical challenge. Several teams have reported good results of radius resurfacing. The goal of our study was to evaluate the usability of the wrist in a new series of patients after surgery. We performed a monocentric retrospective study on the data of the medical files. All the included patients were older than 65 years and received a wrist hemiarthroplasty according to the criteria that have been established by the in charge medical team. Eleven patients have been included, their average age was 80.4 years old, and the average follow-up was 18.3 months. The average QuickDASH Score was 59 (27-95). The Visual Analogue Scale for pain was in average 3.8/10 and the average mobility was: flexion 36° (12-50), extension 27° (12-50), radial deviation 15° (12-15), ulnar deviation 26° (12-40), pronation-supination range of motion 164° (150-170). The average measured strength was 44% (16-72%) of the strength of the unaffected hand. Our results are rather modest, probably because of insufficient follow-up and very severe fractures. Furthermore, the implant that has been used does not take into account the distal radioulnar joint. Another bound of this treatment is the complexity of surgical revision in case of bad result. So far, hemiarthroplasty cannot be considered as the standard treatment for complex fractures of the distal radius.
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Affiliation(s)
- F Anger
- Hôpital d'Instruction des armées Sainte-Anne, service de chirurgie orthopédique et traumatologie, 2, boulevard Sainte-Anne, 83200 Toulon, France.
| | - R Legré
- AP-HM, hôpital de la Timone, service de chirurgie de la main, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - M K Nguyen
- Hôpital d'Instruction des armées Sainte-Anne, service de chirurgie orthopédique et traumatologie, 2, boulevard Sainte-Anne, 83200 Toulon, France
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Vertesich K, Puchner SE, Staats K, Schreiner M, Hipfl C, Kubista B, Holinka J, Windhager R. Distal femoral reconstruction following failed total knee arthroplasty is accompanied with risk for complication and reduced joint function. BMC Musculoskelet Disord 2019; 20:47. [PMID: 30704448 PMCID: PMC6357401 DOI: 10.1186/s12891-019-2432-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/22/2019] [Indexed: 12/02/2022] Open
Abstract
Background Substantial bone loss following failed total knee arthroplasty (TKA) represents a major challenge in revision arthroplasty, that can require distal femoral reconstruction (DFR). In this study, we aimed to assess the clinical outcome and the complication frequencies of individuals who underwent DFR with modular megaprostheses. Additionally, we aimed to compare functional outcome measures after DFR in these sophisticated cases to an age-matched control group of total knee prostheses to quantify the potential loss of function. Methods A retrospective chart review of 30 consecutive patients after DFR from 1997 to 2017 with a mean age of 74.38 years (± 10.1) was performed. Complications were classified according to the Henderson classification. Knee Society Score (KSS) was calculated and range of motion (ROM) was assessed. Results Thirteen (43.3%) patients had at least one complication requiring revision surgery. Revision-free survival was 74.8% at one year, 62.5% at three and 40.9% at 10 years post-op. Soft-tissue failure complications were found in three (10.0%) patients, aseptic loosening in four (13.3%) patients, structural failure in one (3.3%) patient and infection in eight (26.6%) patients. Of those with infection, five (16.6%) experienced ongoing prosthetic joint infection and three (10.0%) developed new infection after distal femur reconstruction. Patients with DFR achieved 69.3% of KSS pain score, 23.1% KSS function score and 76.2% of ROM compared to patients with primary TKA. Conclusions DFR after failed TKA represents a treatment procedure with high risk for complication in this particular group. Despite the prospect of rapid postoperative mobilization, reduced functionality, range of motion and mobilization have to be considered when choosing this treatment option.
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Affiliation(s)
- Klemens Vertesich
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stephan E Puchner
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Kevin Staats
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Markus Schreiner
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Hipfl
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bernd Kubista
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Johannes Holinka
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Ebied A, Zayda A, Marei S, Elsayed H. Medium term results of total knee arthroplasty as a primary treatment for knee fractures. SICOT J 2018; 4:6. [PMID: 29547115 PMCID: PMC5855497 DOI: 10.1051/sicotj/2017060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/16/2017] [Indexed: 12/18/2022] Open
Abstract
Introduction: Successful treatment of knee comminuted periarticular fractures associated with osteoporosis and pre-existing arthritis is a challenging task. Methods: This is a prospective study on 27 patients who had comminuted intra and periarticular knee fractures and pre-existing arthritis. Fractures were classified according to Muller's AO classification. Primary knee arthroplasty was performed ± internal fixation following 4 weeks of splinting. A stem was added to the tibial tray and Legacy Constrained Condylar Knee (LCCK) or Rotating Hinge (RH) prosthesis were used depending on the level of ligament damage and bone defects. The Knee Society Score (KSS) and radiological evaluation were performed at 3, 6 and 12 months then annually thereafter. Results: The average age of this group of patients was 63 years (range 59–74). Sixteen knees received primary femoral component and Posterior Stabilized insert, while 8 had LCCK. RH implants were chosen in 2 and distal femoral replacement was necessary in one knee. Twenty five patients were available for the final review at an average 6 years in whom the KSS was 80 (range 75–89) points. All patients achieved full knee extension and average knee flexion of 110° (range 90–135°). One knee needed re-admission for early Debridement Antibiotic Irrigation and Retention (DAIR) but none of the knees was revised or awaiting revision. Conclusion: Knee arthroplasty achieves highly successful outcome when performed as a primary treatment for comminuted intra and periarticular knee fractures in elderly patients. Survival of implants and functional range of movement at midterm are excellent.
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Affiliation(s)
- Ayman Ebied
- Menoufia University Hospitals, Shebin El Kom, Egypt
| | - Ahmed Zayda
- Menoufia University Hospitals, Shebin El Kom, Egypt
| | - Sameh Marei
- Menoufia University Hospitals, Shebin El Kom, Egypt
| | - Hany Elsayed
- Menoufia University Hospitals, Shebin El Kom, Egypt
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Aurich M, Koenig V, Hofmann G. Comminuted intraarticular fractures of the tibial plateau lead to posttraumatic osteoarthritis of the knee: Current treatment review. Asian J Surg 2018; 41:99-105. [DOI: 10.1016/j.asjsur.2016.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/18/2016] [Accepted: 11/24/2016] [Indexed: 11/30/2022] Open
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Hoellwarth JS, Fourman MS, Crossett L, Goodman M, Siska P, Moloney GB, Tarkin IS. Equivalent mortality and complication rates following periprosthetic distal femur fractures managed with either lateral locked plating or a distal femoral replacement. Injury 2018; 49:392-397. [PMID: 29208310 DOI: 10.1016/j.injury.2017.11.040] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 11/23/2017] [Accepted: 11/29/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Management of distal femur fractures above total knee arthroplasty (TKA) remains challenging. Two common surgical options are locked lateral plating (LLP) and distal femoral arthroplasty (DFR). Unfortunately, approximately 30-50% of patients may die within one year of injury, require further surgery, or not regain prior mobility performance. We compared 87 LLP to 53 DFR patients - to our knowledge the largest comparative study - focusing on 90- and 365-day mortality, mobility maintenance, and further surgery. METHODS We performed a retrospective review of patients at least 55 years old who sustained femur fractures near a primary TKA (essentially OTA-33 or Su types 1, 2, or 3) from 2000 to 2015 assigning cohort based on treatment: LLP or DFR. We excluded patients having prior care for the injury, whose surgery was not for fracture (e.g. loosening), or having other surgical intervention (e.g. intramedullary nail). RESULTS Results Cohorts were similar based on body mass index and age adjusted Charlson Comorbidity Index (aaCCI). LLP was more common than DFR for fractures above and at the level of the implant, but similar for fractures within the implant for patients with aaCCI ≥ 5. LLP and DFR had similar mortality at 90 days (9% vs 4%) and 365 days (22% vs 10%), need for additional surgery (9% vs 3%), and survivors maintaining ambulation (77% vs 81%). Patients whose surgery occurred 3 or more days after presentation had similar mortality risk to those whose surgery was before 3days. The mean age of one year survivors was 77 whereas for patients who died it was 85. Neither surgical choice nor aaCCI was associated with increased risk in time to surgery. CONCLUSIONS Fracture location, remaining bone stock, and patient's prior mobility and current comorbidities must guide treatment. Our study suggests that 90- and 365-day mortality, final mobility, and re-operation rate are not statistically different with LLP vs DFR management.
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Affiliation(s)
- Jason S Hoellwarth
- Department of Orthopaedic Surgery, Division of Traumatology, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA, USA.
| | - Mitchell S Fourman
- Department of Orthopaedic Surgery, Division of Traumatology, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA, USA
| | - Lawrence Crossett
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 5230 Centre Avenue, Suite 415, Pittsburgh, PA, 15232, USA, USA
| | - Mark Goodman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 5230 Centre Avenue, Suite 415, Pittsburgh, PA, 15232, USA, USA
| | - Peter Siska
- Department of Orthopaedic Surgery, Division of Traumatology, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA, USA
| | - Gele B Moloney
- Department of Orthopaedic Surgery, Division of Traumatology, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA, USA
| | - Ivan S Tarkin
- Department of Orthopaedic Surgery, Division of Traumatology, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA, USA
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Parratte S, Ollivier M, Argenson JN. Primary total knee arthroplasty for acute fracture around the knee. Orthop Traumatol Surg Res 2018; 104:S71-S80. [PMID: 29199087 DOI: 10.1016/j.otsr.2017.05.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 02/02/2023]
Abstract
Relatively poor results have been reported with open reduction and internal fixation of complex fractures around the knee in elderly osteoporotic patients, and primary total knee arthroplasty (TKA) has been proposed as an alternative solution. While limiting the number of procedures, it meets two prerequisites: (1) to save the patient's life, thanks to early weight-bearing, to limit decubitus complications; and (2) to save knee function and patient autonomy, thanks to early knee mobilization. There are 3 main indications: complex articular fractures in elderly patients with symptomatic osteoarthritis prior to fracture; complex articular fractures of the tibial plateau in elderly patients whose bone quality makes internal fixation hazardous; and major destruction of the distal femur in younger patients. Although admitted in emergency, these patients require adequate preoperative management, including a multidisciplinary approach to manage comorbidities, control of anemia and pain, and assessment and management of vascular and cutaneous conditions. Preoperative planning is crucial, to order appropriate implants and materials that may be needed intraoperatively. Surgical technique is based on the basic principles of revision surgery as regards choice of implant, steps of reconstruction, bone defect management and implant fixation. For complex fractures of the distal femur, primary temporary reduction is a useful "trick", to determine the level of the joint line and femoral rotation. Complementary internal fixation may be required in case of diaphyseal extension of the fracture and to prevent inter-prosthetic fractures. In the literature, the results of primary TKA for fracture are encouraging and better than for secondary TKA after failure of non-operative treatment or internal fixation, with lower rates of revision and complications, earlier full weight-bearing and better functional results. Loss of autonomy is, however, frequent, and 1-year mortality is high, especially following complex femoral fractures in the elderly.
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Affiliation(s)
- S Parratte
- CNRS, ISM UMR 7287, Aix-Marseille université, 13288 Marseille cedex 09, France; Service de chirurgie orthopédique, institut du mouvement et de l'appareil locomoteur, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France.
| | - M Ollivier
- CNRS, ISM UMR 7287, Aix-Marseille université, 13288 Marseille cedex 09, France; Service de chirurgie orthopédique, institut du mouvement et de l'appareil locomoteur, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - J-N Argenson
- CNRS, ISM UMR 7287, Aix-Marseille université, 13288 Marseille cedex 09, France; Service de chirurgie orthopédique, institut du mouvement et de l'appareil locomoteur, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
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Revision knee arthroplasty using a distal femoral replacement prosthesis for periprosthetic fractures in elderly patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:95-102. [DOI: 10.1007/s00590-017-2009-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
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Atrey A, Hussain N, Gosling O, Giannoudis P, Shepherd A, Young S, Waite J. A 3 year minimum follow up of Endoprosthetic replacement for distal femoral fractures - An alternative treatment option. J Orthop 2017; 14:216-222. [PMID: 28115800 DOI: 10.1016/j.jor.2016.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/25/2016] [Indexed: 01/16/2023] Open
Abstract
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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Affiliation(s)
- A Atrey
- St Michael's Hospital, Toronto, Canada
| | | | | | | | - A Shepherd
- Warwick Hospital Orthopaedic Research Unit, UK
| | - S Young
- Warwick Hospital Orthopaedic Research Unit, UK
| | - J Waite
- Warwick Hospital Orthopaedic Research Unit, UK
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Marczak D, Kowalczewski J, Czubak J, Okoń T, Synder M, Sibiński M. Short and mid term results of revision total knee arthroplasty with Global Modular Replacement System. Indian J Orthop 2017; 51:324-329. [PMID: 28566786 PMCID: PMC5439320 DOI: 10.4103/0019-5413.205684] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The original knee megaprostheses with fixed or rotating hinge articulation were custom made and only used for reconstruction of the knee following distal femoral or proximal tibial tumor resections. The aim of the study was to analyze the short- and mid-term results of revision total knee arthroplasty with Global Modular Replacement System (GMRS) used in difficult situations not amenable to reconstruction with standard total knee replacement implants. MATERIALS AND METHODS Nine patients (9 knees) were treated with this comprehensive modular implant system, with a mean age of 73.7 years (range 56-83 years) and a mean followup of 5 years (range 3-8 years). Two patients were treated for distal femoral nonunion, five for distal femur periprosthetic fracture and two for periprosthetic joint infection. RESULTS The mean Knee Society Score: Knee and functional scores were 77.9 and 40 points, respectively. All demonstrated full extension and flexion was at least 90°. Recurrence of infection was present in one patient. No signs of loosening, dislocation, or implant failure were observed. CONCLUSIONS Based on our small series of patients that represent severe cases, GMRS provides relatively good mid-term functional results, pain relief, and good implant survivorship with a low complication rate. This salvage procedure allows elderly, infirm patients to regain early ambulatory ability.
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Affiliation(s)
- Dariusz Marczak
- Department of Orthopaedics, Postgraduate Medical Education Center, Otwock, Poland
| | - Jacek Kowalczewski
- Department of Orthopaedics, Postgraduate Medical Education Center, Otwock, Poland
| | - Jarosław Czubak
- Department of Orthopaedics, Postgraduate Medical Education Center, Otwock, Poland
| | - Tomasz Okoń
- Department of Orthopaedics, Postgraduate Medical Education Center, Otwock, Poland
| | - Marek Synder
- Department of Orthopaedics, Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland
| | - Marcin Sibiński
- Department of Orthopaedics, Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland,Address for correspondence: Dr. Marcin Sibiński, Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland. E-mail:
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Hart GP, Kneisl JS, Springer BD, Patt JC, Karunakar MA. Open Reduction vs Distal Femoral Replacement Arthroplasty for Comminuted Distal Femur Fractures in the Patients 70 Years and Older. J Arthroplasty 2017; 32:202-206. [PMID: 27449717 DOI: 10.1016/j.arth.2016.06.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The ideal management of distal femur fractures in the elderly is unclear. Acute arthroplasty has the theoretical advantage of earlier mobilization. We examined the outcomes of patients 70 years and older who underwent open reduction internal fixation (ORIF) vs distal femoral replacement (DFR) for comminuted, intra-articular distal femur fractures. METHODS A retrospective review of patients with AO/OTA classification 33C distal femur fractures treated with either ORIF or DFR was performed. Outcomes including all-cause reoperation, length of stay, fracture union, postoperative complications, use of ambulatory device and living situation at 1 year, and mortality were evaluated. RESULTS The study cohort included 38 patients: 10 underwent DFR and 28 ORIF. Mean patient age for both cohorts was 82 years. No difference in comorbidities or mechanism of injury was found between groups. The incidence of reoperation was 11% in the ORIF group and 10% in the DFR group. In the ORIF group, the average time to fracture union was 24 weeks, with a nonunion incidence of 18%. Twenty-three percent of ORIF group were wheelchair dependent vs none in the DFR cohort, although not statistically significant. Differences between the groups with respect to all-cause reoperation, living situation or need for ambulatory device at 1 year, and 1-year mortality did not reach statistical significance. CONCLUSION Nearly 1 in 5 patients older than 70 years developed a nonunion after ORIF of an intra-articular distal femur fracture. At 1-year follow-up, all patients in DFR group were ambulatory while 1 in 4 in the ORIF group were wheelchair bound.
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Affiliation(s)
- Gavin P Hart
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC
| | - Jeffrey S Kneisl
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC
| | - Bryan D Springer
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC
| | - Joshua C Patt
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC
| | - Madhav A Karunakar
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC
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Choi HS, Nho JH, Kim CH, Kwon SW, Park JS, Suh YS. Revision Arthroplasty Using a MUTARS® Prosthesis in Comminuted Periprosthetic Fracture of the Distal Femur. Yonsei Med J 2016; 57:1517-22. [PMID: 27593884 PMCID: PMC5011288 DOI: 10.3349/ymj.2016.57.6.1517] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/15/2016] [Accepted: 03/29/2016] [Indexed: 11/27/2022] Open
Abstract
Periprosthetic fractures after total knee arthroplasty (TKA) are gradually increasing, reflecting extended lifespan, osteoporosis, and the increasing proportion of the elderly during the past decade. Supracondylar periprosthetic femoral fracture is a potential complication after TKA. Generally, open reduction and internal fixation are the conventional option for periprosthetic fracture after TKA. However, the presence of severe comminution with component loosening can cause failure of internal fixation. Although the current concept for periprosthetic fracture is open reduction and internal fixation, we introduce an unusual case of revision arthroplasty using a MUTARS® prosthesis for a comminuted periprosthetic fracture in the distal femur after TKA, with technical tips.
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Affiliation(s)
- Hyung Suk Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Jae Hwi Nho
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea.
| | - Chung Hyun Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Sai Won Kwon
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
| | - Jong Seok Park
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
| | - You Sung Suh
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
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Brogan K, Akehurst H, Bond E, Gee C, Poole W, Shah NN, McChesney S, Nicol S. Delay to surgery does not affect survival following osteoporotic femoral fractures. Injury 2016; 47:2294-2299. [PMID: 27522234 DOI: 10.1016/j.injury.2016.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/03/2016] [Indexed: 02/02/2023]
Abstract
AIMS Fragility femoral fractures occur in a similar group of patients to hip fractures but they are not routinely managed along standardised guidelines. This study looked specifically at whether delay to surgery has an impact on mortality and morbidity. PATIENTS AND METHODS An international, multi-centre retrospective review was carried including all patients over 60 years with fragility femoral fractures, including most periprosthetic fractures, between December 2008-2014. RESULTS 243 patients met the inclusion criteria with mean follow-up 25 months. 197 (81%) were female with mean age 81 years. Median time to surgery was 2 days; 39% were operated on <24h, 23% 24-48h, and 37% at >48h. 3- and 12-month mortality were 14% (95% CI: 9-18%) and 26% (20-31%) respectively. On Kaplan-Meier plotting, relationships were apparent between survival and sex, and ASA grade, but not delay to surgery or fracture type. CONCLUSION Fragility femoral fractures have equivalent mortality to hip fractures but we found no link between delay to surgery and mortality. We believe it is safe to delay surgery, within reason, whilst their acute and chronic medical problems are optimised. We believe this information will help develop guidelines similar to hip fracture pathways.
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Affiliation(s)
- Kit Brogan
- Department of Orthopaedics, Royal Sussex County Hospital, Eastern Rd, Brighton BN2 5BE, UK.
| | - Harold Akehurst
- Department of Orthopaedics, Worthing hospital, Lyndhurst Rd, Worthing BN11 2DH, UK
| | - Elizabeth Bond
- Department of Orthopaedics, Waikato Hospital, Selwyn Street and Pembroke Street, Hamilton 3204, New Zealand
| | - Chris Gee
- Department of Orthopaedics, Royal Sussex County Hospital, Eastern Rd, Brighton BN2 5BE, UK
| | - William Poole
- Department of Orthopaedics, Royal Sussex County Hospital, Eastern Rd, Brighton BN2 5BE, UK
| | - Nirav N Shah
- Department of Orthopaedics, Worthing hospital, Lyndhurst Rd, Worthing BN11 2DH, UK
| | - Steve McChesney
- Department of Orthopaedics, Waikato Hospital, Selwyn Street and Pembroke Street, Hamilton 3204, New Zealand
| | - Stephen Nicol
- Department of Orthopaedics, Royal Sussex County Hospital, Eastern Rd, Brighton BN2 5BE, UK
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Abstract
OBJECTIVES To evaluate outcomes and complications using cemented modular distal femoral replacement in elderly patients with distal femoral fractures. DESIGN Retrospective chart review, case series. SETTING A Level 1 and Level 2 trauma center, both tertiary referral hospitals. PATIENTS/PARTICIPANTS Eighteen patients older than 60 years (average age 77 years) who had cemented distal femoral replacement for distal femoral fractures (comminuted, intraarticular, osteoporotic, arthritic) between 2005 and 2013. Patients with previous knee surgery were excluded. INTERVENTION Cemented modular distal femoral replacement. MAIN OUTCOME MEASURES Implant status, complications, Knee Society Score, Musculoskeletal Tumor Society score, and Western Ontario and McMaster Osteoarthritis Index. RESULTS All patients were extremely or very satisfied with their outcomes. For patients with functional outcome data, Knee Society Score averaged 85.7 with a functional score of 35, Musculoskeletal Tumor Society score averaged 19.2, and Western Ontario and McMaster Osteoarthritis Index score averaged 23.1 at an average follow-up of 2.3 years. Range of motion was 1-99 degrees. Implant-related complications occurred in 2 patients (11%); one required revision to total femoral replacement because of periprosthetic fracture and the other had a deep infection that required exchange of the components. No patient had aseptic loosening or patellar maltracking. There were no perioperative deaths or late amputations. CONCLUSIONS Cemented modular distal femoral replacement is a viable treatment option in elderly patients that permits immediate full weight-bearing, with most patients returning to preoperative functional status. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Hagedorn JC, Achor TS. Osteoporotic distal femoral fractures. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ochs BG, Schreiner AJ, de Zwart PM, Stöckle U, Gonser CE. Computer-assisted navigation is beneficial both in primary and revision surgery with modular rotating-hinge knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:64-73. [PMID: 25239506 DOI: 10.1007/s00167-014-3316-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 09/09/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of the present study was to explore the effect of navigation on the reconstruction of the mechanical leg axis, implant positioning and the restoration of the joint line in hinged knee arthroplasty in vivo. We present the first 1- to 3-year clinical and radiological results following computer-navigated implantation of the EnduRo modular rotating-hinge knee arthroplasty system (Aesculap AG, Tuttlingen, Germany) as a primary or revision implant. METHODS Thirty-one patients were analysed retrospectively. Indication was revision surgery in 18 patients and complex primary surgery in 13. The clinical and radiological results of 31 patients with a minimum follow-up of 12 months (mean 22.2 ± 6.2 months) were recorded. Age at follow-up was 55.2 ± 9.9 years. RESULTS The absolute varus-valgus deviation from the neutral mechanical leg axis was determined at 5.1° ± 5.1° preoperatively and 2.1° ± 1.4° postoperatively. No intraoperative complications or problems with the navigation system were observed. At latest follow-up, no component loosening was detected. Based on the Knee Society Score, a knee score of 64.9 ± 17.7 points and a function score of 67.2 ± 27.3 points were achieved. CONCLUSIONS Encouraging short-term clinical and radiological results with the computer-navigated implantation of the modular rotating-hinge EnduRo knee arthroplasty system were found in both primary and revision surgery. The navigation facilitated the reconstruction of the leg axis, implant positioning and the restoration of the joint line. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Björn G Ochs
- BG Trauma Centre, Eberhard Karls University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Anna J Schreiner
- BG Trauma Centre, Eberhard Karls University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Peter M de Zwart
- BG Trauma Centre, Eberhard Karls University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Ulrich Stöckle
- BG Trauma Centre, Eberhard Karls University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Christoph Emanuel Gonser
- BG Trauma Centre, Eberhard Karls University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany.
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