Total knee arthroplasty following prior distal femoral fracture

• Published in: The knee 2002-12, Vol.9 (4), p.267-274
• Main Authors: Papadopoulos, Elias C, Parvizi, Javad, Lai, Choon H, Lewallen, David G
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arthritis; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - methods; Female; Femoral fracture; Femoral Fractures - complications; Femoral Fractures - surgery; Fractures, Malunited - complications; Fractures, Malunited - surgery; Hematoma - etiology; Humans; Knee Joint - physiology; Knee Prosthesis - classification; Locomotion - physiology; Male; Middle Aged; Osteoarthritis, Knee - complications; Osteoarthritis, Knee - surgery; Pain Measurement; Range of Motion, Articular - physiology; Reoperation; Surgical Wound Dehiscence - etiology; Surgical Wound Infection - etiology; Time Factors; Total knee arthroplasty; Treatment Outcome
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/S0968-0160(02)00046-7

Background: Femoral fracture may predispose the knee to the development of post-traumatic arthritis by either a direct intra-articular injury or residual limb malalignment. Malunion, intra-articular osseous defects, limb malalignment, retained internal fixation devices, and compromised surrounding soft tissues may in turn affect the outcome of total knee arthroplasty (TKA) in these patients. The aim of our study was to evaluate the result of TKA in patients with previous distal femoral fracture. Methods: The results of 48 cemented condylar total knee arthroplasties, performed between 1980 to 1998, in 47 patients with a previous distal femoral fracture were reviewed. There were 37 females and 10 males with an average age of 65 years (range, 19–84 years). Follow-up averaged 6.2 years (range, 2–16 years). No patients were lost to follow-up. Results: At the time of arthroplasty a femoral fracture non-union was present in three knees, all of which were treated with a long stem cemented femoral component and bone grafting. Malunion, defined as angulation greater than 10° in the coronal plain or greater than 15° in the sagittal plain, was present in 21 knees. Of these, six underwent distal femoral osteotomy during TKA. In the remaining 15 patients, with a malunion, the deformity was addressed by alterations in the orientation and location of bone resection. Other procedures were commonly needed at the time of arthroplasty and included: lateral retinacular release (22 knees), extensor mechanism realignment (eight knees), and collateral ligament reconstruction (two knees). The mean pre-operative Knee Society Scores were 40 (range, 0–80) for pain and 48 (range, 0–100) for function and improved significantly to a mean of 84 (range, 37–99) and 66 (range, 0–100) points, respectively, at the latest follow-up ( P