Treatment of Femoral Fractures Following Total Knee Arthroplasty

ABSTRACT

PURPOSE: To analyse the results of the treatment of femoral fractures following total knee arthroplasty (TKA) and to discuss about factors determining operative methods. MATERIALS AND METHODS: Between August 1993 and March 2001, 11 knees in 11 patients were treated for femoral fracture following TKA in Seoul Sacred Heart General Hospital. Only one case was treated with cast immobilization and ten cases were treated with operative method. In operative cases, before choosing the fixation devices, we considered the location, displacement and comminution of fractures and general conditions of patients. We analyzed clinical results according to the tibiofemoral angle, range of motion(ROM), and the knee rating score of Hospital for Special Surgery(HSS). RESULTS: Among 1133 knees in 764 patients with primary TKA, eleven cases underwent femoral fractures following TKA. The incidence was 0.9%. Among ten cases which were treated operatively, four cases had severe displacement without osteoporosis and were treated with dynamic compression plate(DCP) and screws. Three cases had displaced comminuted fractures with ostoporosis and medical problems, so they were treated with Ender nailing. Two cases had mild displacement and comminution and were treated with retrograde interlocking IM nailing. One case was with uncomminuted fracture with cardiopulmonary insufficiency and old age. Because initial closed reduction was failed, open reduction was performed and cancellous screw fixation was done. The average follow up period after fracture was 19 months. Radiologically, tibiofemoral angle was valgus 6.2 degrees on an average before fracture and valgus 8.2 degrees at the last follow up. ROM was 109 degrees on an average before fracture and 98 degrees at the last follow up and HSS knee rating score averaged 84 points before fracture and 78 points at the last follow up. CONCLUSION: Selection of treatment methods and fixation devices according to fracture type was important for satisfactory functional results, patient's general conditions and medical problems must be considered.