The role of a primary arthroplasty in the treatment of proximal tibia fractures in orthogeriatric patients

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The role of a primary arthroplasty in the treatment of proximal tibia fractures in orthogeriatric patients
Key Take-Away: 

The study proposes that primary total knee arthroplasty for tibia plateau fractures in orthogeriatric patients is a good alternative to the osteosynthetic treatment.

The total knee arthroplasty (TKA) is the standard treatment for patients with progressive, symptomatic gonarthrosis. In the current literature, there are only few studies and that too with a very small patient population of less than 15, dealing with the primary arthroplasty for complex tibia plateau fractures.

ABSTRACT: 
Background: 

The total knee arthroplasty (TKA) is the standard treatment for patients with progressive, symptomatic gonarthrosis. In the current literature, there are only few studies and that too with a very small patient population of less than 15, dealing with the primary arthroplasty for complex tibia plateau fractures.

However, the TKA for a proximal tibia fracture seems to be a promising alternative, especially for the increasing number of orthogeriatric patients. For the orthogeriatric patient, the underlying cause is mostly a low energy trauma. They have more complex fractures with a big defect of the articular surface due to which, most of the patients who undergo an open reduction and internal fixation (ORIF) will only be allowed a partial weight bearing after surgery. But for the elderly patient the immediate postoperative mobilization with fullweight bearing is vital to maintain the mobility they had prior to the operation. It is a known fact that if, due to reduced proprioceptive sensibilities or to preexisting comorbidities, a partial weight bearing cannot be achieved, the risk of thrombosis, pulmonary embolism, and pneumonia, as well as the reduction of muscular mass (and proprioceptive abilities), increases postoperatively. Those factors may cause complete loss of mobility and also increases rate of the overall mortality.

Rationale behind research

  1. There are few publications dealing with the primary TKA for patients with a proximal tibia fracture.

  2. Thus, this study was conducted to explore the role of primary arthroplasty in the treatment of proximal tibia fractures in orthogeriatric patients

  • Objective

  • To evaluate the role of primary arthroplasty in the treatment of proximal tibia fractures in orthogeriatric patients

Methods: 

  • Study outcomes

  • Knee Society Score

  • The WOMAC Score

NOTE: Apart from the scores, some statistical data of each patient: the age at the time of surgery, the AO-classification of the fracture, the comorbidities, the type of prosthesis, the average length of the operation & hospitalization and the postoperative complications were recorded.

Results: 

  • Outcomes

  • Mean age of the patients at the time of surgery was 78.4 years. Average length of the operation was 119 (72–150) minutes and the average length of hospitalization was 26.7 (15–35) days.

  • Knee Society Score & WOMAC Score: The American Knee Society Clinical Rating Score (KSS) is composed of two components, a “knee score” (KSS1) and a “functional score” (KSS2) (80–100 points = excellent, 70–79 = good, 60–69 = fair, and below 60 = poor). In our study the patients achieved KSS1 of mean 81.1 points (94–54 points), a KSS2 of mean 74.5 (100 to −20 points. In our study, the patients achieved WOMAC score of mean 78.6 points (96.2 to 36.7 points).

  • A subgroup population who had been treated with TKA for proximal tibia fracture between 01/2013 and 12/2014 was set up and better functional results were observed as compared to the overall population group. These patients achieved a KSS1 of mean 87.2 points (94–69 points), a KSS2 of mean 77.2 points (100 to −20 points), and the WOMAC score of mean 83.2 points (36.7 and 97.7 points).

Figure 1: Comparison of KSS and WOMAC score between overall population and subgroup population

Conclusion: 

According to the current literature, there is very limited experience with a TKA for a proximal tibia fracture. The concept of primary total knee arthroplasty (TKA) for tibia plateau fractures in orthogeriatric patients seems to be a good option. The results of this study are comparable to the good clinical results seen after a TKA shown in the literature.

Because of the benefits presented in this study for the geriatric patients, especially immediate postoperative mobilization with full-weight bearing, associated risks like thrombosis, pulmonary embolism, and pneumonia could be reduced. Additionally, the loss of the proprioceptive sensibilities and the loss of muscle mass can be minimized. Also, these factors, in turn, may reduce the risk of the overall mortality rate and loss of mobility in those patients. 

BioMed Research International 2016
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