[Total knee arthroplasty for recent severe fracture of the proximal tibial epiphysis in the elderly subject].
OBJECTIVE
Bone comminution, serious cartilage damage, and the poor mechanical quality of osteoporotic bone create a difficult challenge for osteosynthesis of joint fractures in the elderly subject. Poor results with certain hip, elbow and shoulder fractures have lead certain authors to propose emergency arthroplasty in selected cases. We report our experience with four knee arthroplasties implanted for recent severe fracture of the proximal tibial epiphysis in elderly subjects.


METHODS
Four independent patients aged over 75 years presented a severe comminutive fracture of the proximal epiphysis of the tibia (Three Schatzker 5, one Schatzker 4). After obtaining the patients' informed consent, early knee arthroplasty was performed. A long-stem cemented tibial piece was used on which the epiphysis was reconstructed. Implants providing support for ligament deficits were used in all cases. Immediate weight-bearing was authorized.


RESULTS
Follow-up ranged from two to seven years. The IKS function score (15, 60, 100, 100) depended on the patient's general status. The IKS knee score was excellent for three knees (90, 95, 95), and fair in one (45). Re-operations were not needed in any of the patients. All x-rays showed bone healing with correctly aligned limbs (less than 2 degrees deformation). There were no lucent lines at last follow-up.


CONCLUSIONS
Early arthroplasty for complex fractures of the proximal epiphysis of the tibia is a realistic option. Using a cemented long-stem tibial piece ensures primary stability sufficient for early weight-bearing before bone healing. Use of a constrained prosthesis, or better a hinged prosthesis, can be questioned but avoids the difficulty of ligament balance on an osteoporotic knee with a destroyed joint surface. None of the patients required reoperation and the results in terms of pain were excellent. The overall outcome depends on the general status of the patient.
Nourissat
G
G
Service de Chirurgie Orthopédique, Hôpital Saint-Antoine, Paris.
Hoffman
E
E
Hémon
C
C
Rillardon
L
L
Guigui
P
P
Sautet
A
A
D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D004838:Epiphyses / Q000293:injuries* / Q000601:surgery; D005500:Follow-Up Studies; D018460:Fractures, Comminuted / Q000601:surgery; D006801:Humans; D007595:Joint Prosthesis; D016059:Range of Motion, Articular / Q000502:physiology; D013978:Tibial Fractures / Q000601:surgery*; D016474:Weight-Bearing / Q000502:physiology; D014945:Wound Healing / Q000502:physiology