Knee arthroplasty for acute fractures around the knee

Abstract

▪ Results of open reduction and internal fixation for complex articular fractures around the knee are poor, particularly in elderly osteoporotic patients. ▪ Open reduction and internal fixation may lead to an extended hospital stay and non-weight-bearing period. ▪ This may lead to occurrence of complications related to decubitus such as thrombo-embolic events, pneumonia and disorientation. ▪ Primary arthroplasty can be a valuable option in a casebased and patient-specific approach. It may reduce the number of procedures and allow early full weight-bearing, avoiding the above-mentioned complications. ▪ There are four main indications: 1) Elderly (osteoporotic) patients with pre-existing (symptomatic) end-stage osteoarthritis. 2) Elderly (osteoporotic) patients with severe articular and metaphyseal destruction. 3) Pathological fractures of the distal femur and/or tibia. 4) Young patients with complete destruction of the distal femur and/or tibia. ▪ The principles of knee (revision) arthroplasty should be applied; choice of implant and level of constraint should be considered depending on the type of fracture and involvement of stabilizing ligaments. The aim of treatment is to obtain a stable and functional joint. ▪ Long-term data remain scarce in the literature due to limited indications.