Published online May 18, 2022. doi: 10.5312/wjo.v13.i5.454
Peer-review started: December 29, 2021
First decision: February 21, 2022
Revised: March 19, 2022
Accepted: April 27, 2022
Article in press: April 27, 2022
Published online: May 18, 2022
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.
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.
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.
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.
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.
Core Tip: We evaluated safety and efficacy of a knee megaprosthesis in the setting of complex fractures of the distal femur in elderly patients with a short-term follow-up. We retrospectively evaluated 11 patients over the age of 85 treated with distal femoral replacement with a fully porous coated metaphyseal sleeve for acute fractures of the distal femur with a minimum follow-up of 2 years. During our study period we observed stability of the implants and improvement in the Visual Analogical Scale, Oxford Knee Score, range of motion, Barthel Index, quality of life and survival.