title: Does primary total knee arthroplasty for acute knee joint fracture maintain autonomy in the elderly? A retrospective study of 21 cases.
abstract: BACKGROUND
  Due to poor results and failure encountered in osteosynthesis of peri-articular fracture of the knee, arthroplasty may be suggested to osteopenic elderly subjects. All osteosynthesis techniques entail loss of independence and are associated with elevated mortality. No studies definitively establish better management of such fractures.
  
  
  OBJECTIVE
  Total arthroplasty provides better autonomy after peri-articular fracture of the knee.
  
  
  METHODS
  Seventy-nine patients aged over 65years were operated on for peri-articular fracture of the knee between April 2008 and March 2013. In 21 cases, treated by a single surgeon, total knee arthroplasty was performed in view of osteopenia or osteoarthritis. Mean age was 79years (range, 68-96years). There were 10 distal femoral and 11 proximal tibial fractures. Mean follow-up was 31months (range, 9-68months). Cases of pathologic fracture, failed osteosynthesis and non-operative management were excluded. All patients showed severe osteopenia on radiology and half already had advanced osteoarthritis.
  
  
  RESULTS
  One-year mortality was 14%. At last follow-up, the revision rate was 9.5%. Fifteen patients were followed up. Mean Parker score fell from 7.2 (range, 2-9) preoperatively to 4.6 (range, 0-9) at last follow-up, indicating loss of independence. At follow-up, mean IKS score was 116.6 (range, 0-192) with mean IKS knee score of 78.4 (range, 0-100) and IKS function score of 38.2 (range, 0-100). Mean Oxford score was 36/60 (range, 18-53). Global IKS and IKS function scores were significantly better in case of ASA-2 than ASA-3 (P<0.05). There was no difference between femoral and tibial fractures in terms of IKS or Oxford score or loss of independence.
  
  
  CONCLUSIONS
  Total knee arthroplasty can be considered for peri-articular fracture of the knee in osteopenic geriatric patients. Although surgical revision was less frequent than after osteosynthesis and resumption of weight-bearing was immediate, autonomy was still impaired. Mortality was comparable to other reports.
  
  
  METHODS
  IV, retrospective study.
authors.affiliation: Service de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France; Université Lille-Nord-de-France, Lille, France. Electronic address: boureau.florian@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Boureau
authors.affiliation: Service de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France; Université Lille-Nord-de-France, Lille, France.
authors.forename: K
authors.initials: K
authors.lastname: Benad
authors.affiliation: Service de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France; Université Lille-Nord-de-France, Lille, France.
authors.forename: S
authors.initials: S
authors.lastname: Putman
authors.affiliation: Service de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France; Université Lille-Nord-de-France, Lille, France.
authors.forename: G
authors.initials: G
authors.lastname: Dereudre
authors.affiliation: Service de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France; Université Lille-Nord-de-France, Lille, France.
authors.forename: G
authors.initials: G
authors.lastname: Kern
authors.affiliation: Service de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France; Université Lille-Nord-de-France, Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Chantelot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D001851:Bone Diseases, Metabolic / Q000150:complications; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D057187:Independent Living; D057072:Intra-Articular Fractures / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*; D016474:Weight-Bearing
keywords: Joint fracture; Knee; Osteoporosis; Peri-articular; Total knee arthroplasty