Total Knee Arthroplasty for Salvage of Nonunion of the Distal Femur in Elderly Patients with Osteoarthritis

ABSTRACT

PURPOSE: We wanted to evaluate performing total knee arthroplasty for the salvage treatment of nonunion of the distal femoral fracture in elderly patients. MATERIALS AND METHODS: From October 2000 to March 2007, 10 patients were treated with total knee arthroplasty for salvage of nonunion of distal femoral fracture. The average age of the patients was 70.3 years (range 60 to 75). The average follow-up period was 31.9 months (range 12 to 90). The original fracture site was the supracondylar area in 9 cases and it was distal to the supracondylar area in 1 case. 6 patients had been treated with an anatomical plate, 3 with a Dynamic Condylar Screw and 1 with retrograde nailing. The radiograghs before knee arthroplasty demonstrated degenerative changes in the knee joint in all patients. The following total knee components were used 7 Legacy Knee-Constrained Condylar (Zimmer) and 3 E-motion (B-Braun). The clinical assessments consisted of radiologic evaluation and the Knee Society knee Score (KSS). RESULTS: There was no malalignment >10degrees in any plane for the revision operation that was due to nonunion. The mean KSS knee score improved from 23 (range 10~31) preoperatively to 81 (range 68~89) postoperatively. The mean knee range of motion at the latest follow-up was 3degrees (range 0~10degrees) to 105degrees (range 90~130degrees). One patient required nonoperative wound care for marginal wound skin necrosis. CONCLUSION: We recommend this treatment modality for nonunion of the distal femoral fracture with coexisting gonarthrosis.