Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation

The aim of this study was to evaluate the bone union, complication rate, clinical and functional outcomes of long-stemmed total knee arthroplasty (TKA) in patients with periprosthetic femoral or tibial shaft fractures and in patients with femoral or tibial shaft fractures with coexisting advanced kn...

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Autores principales:	Dariusz Grzelecki, Dariusz Marczak, Kamil Kwolek, Piotr Dudek, Marcin Tyrakowski, Łukasz Olewnik, Maria Czubak-Wrzosek, Jacek Kowalczewski
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	periprosthetic fracture osteoarthritis revision total knee arthroplasty femur shaft fracture tibial shaft fracture stem extension Medicine R
Acceso en línea:	https://doaj.org/article/185ed438183045f180d5817658c56e49
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spelling	oai:doaj.org-article:185ed438183045f180d5817658c56e492021-11-11T17:33:48ZShaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation10.3390/jcm102149262077-0383https://doaj.org/article/185ed438183045f180d5817658c56e492021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4926https://doaj.org/toc/2077-0383The aim of this study was to evaluate the bone union, complication rate, clinical and functional outcomes of long-stemmed total knee arthroplasty (TKA) in patients with periprosthetic femoral or tibial shaft fractures and in patients with femoral or tibial shaft fractures with coexisting advanced knee osteoarthritis (OA). This retrospective study comprised 25 patients who underwent surgery due to tibial or femoral shaft fractures: (1) with coexisting severe knee OA or (2) with a periprosthetic fracture requiring implant exchange. In all cases, fracture stabilization was performed intramedullary with the use of long-stemmed implants without the use of additional fixation material (plates, screws, or cerclage). Bone union was achieved in 22/25 patients (88%). One patient required revision with additional plate stabilization due to non-union, and asymptomatic partial bone union was observed in two cases. The group with periprosthetic fractures demonstrated good clinical (mean 73.1 ± 13.3) and moderate functional (mean 59.2 ± 18.8) outcomes in the Knee Society Scoring system (KSS). In the group with shaft fracture and coexisting OA significantly higher clinical (excellent results, mean 84.1 ± 11; <i>p</i> = 0.03) and functional (good results, mean 76.2 ± 20.6; <i>p</i> = 0.04) results were noted. There were no statistically significant differences in terms of range of motion (ROM) or complication rate between these two groups. One-stage TKA with a long-stemmed implant without the use of additional fixation material is an effective method for the treatment of femoral or tibial shaft fractures in patients who require joint replacement. Despite being technically demanding, the approach yields bone union and moderate to excellent clinical and functional outcomes with a relatively low complication rate.Dariusz GrzeleckiDariusz MarczakKamil KwolekPiotr DudekMarcin TyrakowskiŁukasz OlewnikMaria Czubak-WrzosekJacek KowalczewskiMDPI AGarticleperiprosthetic fractureosteoarthritisrevision total knee arthroplastyfemur shaft fracturetibial shaft fracturestem extensionMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4926, p 4926 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	periprosthetic fracture osteoarthritis revision total knee arthroplasty femur shaft fracture tibial shaft fracture stem extension Medicine R
spellingShingle	periprosthetic fracture osteoarthritis revision total knee arthroplasty femur shaft fracture tibial shaft fracture stem extension Medicine R Dariusz Grzelecki Dariusz Marczak Kamil Kwolek Piotr Dudek Marcin Tyrakowski Łukasz Olewnik Maria Czubak-Wrzosek Jacek Kowalczewski Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation
description	The aim of this study was to evaluate the bone union, complication rate, clinical and functional outcomes of long-stemmed total knee arthroplasty (TKA) in patients with periprosthetic femoral or tibial shaft fractures and in patients with femoral or tibial shaft fractures with coexisting advanced knee osteoarthritis (OA). This retrospective study comprised 25 patients who underwent surgery due to tibial or femoral shaft fractures: (1) with coexisting severe knee OA or (2) with a periprosthetic fracture requiring implant exchange. In all cases, fracture stabilization was performed intramedullary with the use of long-stemmed implants without the use of additional fixation material (plates, screws, or cerclage). Bone union was achieved in 22/25 patients (88%). One patient required revision with additional plate stabilization due to non-union, and asymptomatic partial bone union was observed in two cases. The group with periprosthetic fractures demonstrated good clinical (mean 73.1 ± 13.3) and moderate functional (mean 59.2 ± 18.8) outcomes in the Knee Society Scoring system (KSS). In the group with shaft fracture and coexisting OA significantly higher clinical (excellent results, mean 84.1 ± 11; <i>p</i> = 0.03) and functional (good results, mean 76.2 ± 20.6; <i>p</i> = 0.04) results were noted. There were no statistically significant differences in terms of range of motion (ROM) or complication rate between these two groups. One-stage TKA with a long-stemmed implant without the use of additional fixation material is an effective method for the treatment of femoral or tibial shaft fractures in patients who require joint replacement. Despite being technically demanding, the approach yields bone union and moderate to excellent clinical and functional outcomes with a relatively low complication rate.
format	article
author	Dariusz Grzelecki Dariusz Marczak Kamil Kwolek Piotr Dudek Marcin Tyrakowski Łukasz Olewnik Maria Czubak-Wrzosek Jacek Kowalczewski
author_facet	Dariusz Grzelecki Dariusz Marczak Kamil Kwolek Piotr Dudek Marcin Tyrakowski Łukasz Olewnik Maria Czubak-Wrzosek Jacek Kowalczewski
author_sort	Dariusz Grzelecki
title	Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation
title_short	Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation
title_full	Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation
title_fullStr	Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation
title_full_unstemmed	Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation
title_sort	shaft fractures in patients requiring primary or revision total knee arthroplasty can be successfully treated with long-stemmed implants without additional fixation
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/185ed438183045f180d5817658c56e49
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Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation

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