Treatment of Supracondylar Fractures Following Total Knee Arthroplasty

Bae, Dae Kyung; Yoon, Kyung Ho; Song, Sang Jun; Shin, Myeung Cheol; Lee, Kyung Won; Kim, Jin Young

Abstract

PURPOSE: To analyze clinical and radiological results of patients who underwent treatment for a femur supracondyle fracture following total knee arthrosplasty(TKA).
MATERIALS AND METHODS
Between January 1991 and March 2005, A total of 33 knees of 30 patients(2 male, 31 female knees) were treated for periprosthetic supracondyle fractures following TKA. The mean age of patients was 60.5 years and the mean follow-up period was 3.5 years(range, 1 year~9 years and 1 month). In accordance with the modified Neer classification, 3 cases were classified as Type 1; 23 cases, Type 2; 4 cases, Type 3; and 3 cases, Type 4. Treatment methods included closed reduction and cast immobilization in 8 cases, Ender nailing in 8 cases, open reduction and internal fixation in 14 cases, and total knee arthroplasty using a long stem in 3 cases.
RESULTS
Among 2,325 knees with primary TKA, 33 cases occurred a supracondylar fracture. The incidence of 1.4%. The range of motion reduced from the mean of 113.1 degrees before the fracture to the mean of 94.3 degrees at the last follow-up. The conservative group reduced from 112.3 degrees to 71.9 degrees while the operative group decreased from 113.3 degrees to 102.0 degrees. The HSS knee rating score declined from the mean of 88.1 points before the fracture to the mean of 81.4 points at the last follow-up. The score of the conservative group was down to 70 points from 87.5 points and that of the operative group decreased to 85.4 points from 88.3 points. The femorotibial angle, which was 6.39 degrees of varus before the fracture, was measured 3.07 degrees of varus at the last follow-up. The femorotibial angle decreased from 6.2 degrees to 1.1 degrees of valgus in the conservative group and from 6.5 degrees to 3.7 degrees of valgus in the operative group. Only one of the total 33 cases had nonunion.
CONCLUSION
In the treatment for the supracondylar fractures of TKA, the decreased amount of postoperative ROM, HSS score and femorotial angle were all less in an operative treatment than conservative treatment. Revision arthroplasty using a long stem showed satisfactory results in patients with component loosening.