title: Femoral corrective osteotomy for malunited supracondylar femoral fracture after TKA in a patient with rheumatoid arthritis.
abstract: This article presents a case of femoral corrective osteotomy for malunited supracondylar femoral fracture after total knee arthroplasty (TKA) in a patient with rheumatoid arthritis. The patient underwent 1-stage bilateral TKA and 2-stage bilateral total hip arthroplasty 17 years prior at our institution. Her fall 10 years before led to a supracondylar femoral fracture that was treated nonoperatively for 3 months and led to malunion. Complaints of mild right knee pain and remarkable varus deformity were observed. On examination, the right knee was not swollen and tender. Range of motion (ROM) of the right knee was 0° to 130°. The patient needed crutches to ambulate. Knee score and function scores, according to the Knee Society clinical rating system, were 65 and 25 points, respectively. Radiographs after malunion showed remarkable varus knee and the femorotibial angle was 197°. At the time of surgery, the components were stable and bone union was completed. Valgus corrective osteotomy of the femur was performed using a retrograde intramedullary nail, with satisfactory results at 10-year follow-up. The patient is able to walk without a cane and has 0° to 130° ROM. Knee and function scores were 88 and 80 points, respectively. Radiographs showed complete bone union and the femorotibial angle was 179° with no loosening of the prostheses. Femoral corrective osteotomy is recommended for malunited supracondylar femoral fracture after TKA.
authors.affiliation: Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo, Japan. ssaito@med.nihon-u.ac.jp
authors.forename: Shu
authors.initials: S
authors.lastname: Saito
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Tokuhashi
authors.forename: Takao
authors.initials: T
authors.lastname: Ishii
authors.forename: Sei
authors.initials: S
authors.lastname: Mori
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hosaka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ishigami
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000209:etiology* / Q000601:surgery*; D017759:Fractures, Malunited / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D010027:Osteotomy / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome