Abstract
Primary cemented arthroplasty of the knee is a viable alternative to open reduction and internal fixation (ORIF) for treatment of osteoporotic fractures about the knee. This permits early return of knee function and weight bearing activity. Stemmed revision total knee arthroplasty implants and techniques are needed, which can be associated with complications of late loosening and periprosthetic fracture. However, for elderly sedentary patients who would not be expected to outlive the durability of the arthroplasty and with fracture patterns in which ORIF may be associated with poor outcomes, primary arthroplasty can be a favorable treatment option.


Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Horwitz DS, Kubiak EN. Surgical treatment of osteoporotic fractures about the knee. J Bone Joint Surg. 2009;91A:2970–82.
Rosen AL, Strauss E. Fractures about the knee in the geriatric patient: fix them or replace them? Oper Tech Orthop. 2002;12:103–8.
Rozen AL, Strauss E. Primary total knee arthroplasty for complex distal femoral fractures in elderly patients. Clin Orthop Relat Res. 2004;425:101–5.
Appleton P, Moran M, Houshian S, Robinson CM. Distal femoral fractures treated by hinged total knee replacement in elderly patients. J Bone Joint Surg. 2006;88B:1065–70.
Pearse EO, Klass B, Bendall SP, Railton GT. Stanmore total knee replacement verses internal fixation for supracondylar fractures of the distal femur in elderly patients. Injury. 2005;36:163–8.
Graham J, Ries M, Pruitt L. Effect of bone porosity on mechanical integrity of the bone cement-interface. J Bone Joint Surg. 2003;85A:1901–8.
Pradhan NR, Gambhir A, Porter ML. Survivorship analysis of 3234 primary knee arthroplasties implanted over a 26-year time period. A study of 8 different implant designs. Knee. 2006;13:7–11.
Rand JA, Trousdale RT, Ilstrup MS, Harmsen S. Factors affecting the durability of primary total knee prosthesis. J Bone Joint Surg. 2003;85A:259–65.
Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF. Rotating hinge total knee replacement: use with caution. J Bone Joint Surg. 2007;89A:1735–41.
Deehan DJ, Murray J, Birdsall PD, Holland JP, Pinder IM. The role of the rotating hinge prosthesis in the salvage Arthroplasty setting. J Arthroplasty. 2008;23:683–8.
•• Parratte S, Bonnevialle P, Pietu G, Saragaglia D, Cherrier B, Lafosse JM. Primary total knee arthroplasty in the management of epiphyseal fracture around the knee. Orthop Traumatol Surg Res. 2011;97(6 Suppl):S87–94. A multicenter retrospective review of 26 patients treated with primary TKA for osteoporotic fractures about the knee identified 6 patients with post-operative systemic complications and four with arthroplastty related complications.
Nau T, Pflegerl E, Erhart J, Vecsei V. Primary total knee Arthroplasty for periarticular fractures. J Arthroplasty. 2003;18:968–71.
In Y, Koh HS, Kim SJ. Cruciate-retaining stemmed total knee Arthroplasty for supracondylar-intercondylar femoral fracture in elderly patients. J Arthroplasty. 2006;21:1074–9.
• Vermeire J, Scheerlinck T. Early primary total knee replacement for complex proximal tibia fractures in elderly and osteoarthritic patients. Acta Orthop Belg. 2010;76:785–93. Twelve patients with osteoporotic proximal tibia fractures and preexisting osteoarthritis were treated with primary TKA using cemented long stemmed components and fixation or excision of the fracture fragments. After an average follow-up of 31 months there were no revisions required.
Schwarz N, Buchinger W, Mähring M, Schedl R, Widhalm HK. Knee arthroplasty as primary therapy for proximal tibial fracture. Unfallchirurg. 2008;111:928–32.
Nourissat G, Hoffman E, Hémon C, Rillardon L, Guigui P, Sautet A. Total knee arthroplasty for recent severe fracture of the proximal tibial epiphysis in the elderly subject. Rev Chir Orthop Reparatrice Appar Mot. 2006;92:242–7.
Davalia J, Malkani A, Palso JM. Supracondylar distal femoral nonunions treated with a megaprostheis in elderly patients: a report of 2 cases. J Orthop Trauma. 2001;15:574–8.
Fujii R, Ueda T, Tamai N, Myoui A, Yoshikawa H. Salvage surgery for persistent nonunion after total knee arthroplasty using a megaprosthesis. J Orthop Sci. 2006;11:401–4.
Yoshino N, Takai S, Watanabe Y, et al. Primary total knee arthroplasty for supracondylar/condylar femoral fractures in osteoarthritic knees. J Arthroplasty. 2001;16:471–5.
• Mortazavi SMJ, Kurd MF, Bender B, Post Z, Parvizi J, Purtill JJ. Distal femoral arthroplasty for the treatment of periprosthetic fractures after total knee arthroplasty. J Arthroplasty. 2012;25:775–80. Twenty patients (22 knees) with periprosthetic distal femur fractures in which the distal femoral bone could not be salvaged due to comminution and osteoporosis were treated with distal femoral replacement. Knee function was effectively restored but there were 10 complications and 5 patients required additional surgery.
Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the knee society scoring system. Clin Orthop Relat Res. 1989;238:13–4.
Kilian U. Total knee replacement for primary treatment of intra-articular tibial head fractures in elderly patients. Unfallchirurg. 2003;106:1046–50.
Disclosure
MD Ries wishes to disclose that he has received compensation as a consultant for Smith and Nephew and Stryker; royalties from Smith and Nephew; and stock/stock options from OrthAlign.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ries, M.D. Primary Arthroplasty for Management of Osteoporotic Fractures about the Knee. Curr Osteoporos Rep 10, 322–327 (2012). https://doi.org/10.1007/s11914-012-0122-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11914-012-0122-3