Acute Primary Total Knee Arthroplasty for Proximal Tibial Fractures in Elderly

Background: Proximal tibial fractures in elderly patients with osteoporosis or knee osteoarthritis (OA) are challengingcases. In the current study, we present our experience with uncommon acute primary total knee arthroplasty (PTKA)in this patient population.Methods: PTKAs were performed following proximal tibial fractures in 30 consecutive patients over 60 years of agewith osteoporosis or knee OA between 2005 and 2009. Three constrained condylar knees (CCK) and no hinged kneeprosthesis were used. Patients were followed up for 4.5±1.1 years.Results: Patients were discharged after 4.6±1.2 days. The postoperative Tegner activity scale (3.5±1.3) was improvedsignificantly compared to the preoperative scale (2.5±1.2) (P<0.001). The knee flexion range was significantly greaterin the operated side (106±13 degrees) compared to the uninjured knee (120±8 degrees) (P<0.001). The two sectionsof knee society knee score (knee and function section) averaged 90.7±6.5 and 69.6±8.8, respectively. All patientsreturned to their previous activities. Based on the visual analogue scale, the patients’ satisfaction and pain at final visitwere scored 8.1±1 and 1.5±1.2, respectively. No infection, thromboembolic events and loosening were observed.Conclusion: PTKA following a proximal tibial fracture in elderly patients with osteoporosis or knee degeneration can beconsidered as a safe alternative for open reduction and internal fixation. PTKA resulted in immediate weight-bearing,improved functional status and patients’ satisfaction. However, functional outcomes were dependent on the generalcondition of 24 the patient. Also, constrained knee prostheses were not necessary for a vast majority of the patients.

Keywords:

Knee Osteoarthritis , Osteoporosis , Proximal tibial fracture , Total knee arthroplasty