Osteosynthesis or arthroplasty of fractures near the knee joint in geriatric patients – a clinical-economical comparison

Abstract

Background The treatment of fractures of the tibial plateau or distal femur often represents a severe problem in geriatric patients. In particular, complex fracture types and concomitant severe osteoporosis are confronted with inferior results following internal fixation. Therefore, primary arthroplasty is increasingly propagated for such particular cases.

Patients, Materials and Methods In 16 patients suffering from fractures of the distal femur or tibial plateau were treated either by internal fixation (n = 8) or primary arthroplasty (n = 8). The outcome of each case was retrospectively analysed according to clinical and economic criteria.

Results In the investigated geriatric patients, primary arthroplasty was significantly superior to internal fixation regarding mobilisation and range of motion without being inferior in cost-effectiveness.

Conclusion Compared to internal fixation, primary arthroplasty represents an efficient and cost-effective therapeutical option for the treatment of complex fractures of the distal femur or tibial plateau of the elderly patient.

Key words

osteoporotic fracture - geriatric orthopaedic trauma - open reduction internal fixation - joint arthroplasty - cost effectiveness

• References/Literatur

• 1 Stevens DG, Beharry R, McKee MD. et al. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma 2001; 15: 312-320
• 2 Rademakers MV, Kerkhoffs GM, Sierevelt IN. et al. Intra-articular fractures of the distal femur: a long-term follow-up study of surgically treated patients. J Orthop Trauma 2004; 18: 213-219
• 3 Pape D, Hoffmann A, Gerich T. et al. [Fractures of the knee joint in the elderly: osteosynthesis versus joint replacement]. Orthopade 2014; 43: 365-373
• 4 Bohm ER, Tufescu TV, Marsh JP. The operative management of osteoporotic fractures of the knee: to fix or replace?. J Bone Joint Surg Br 2012; 94: 1160-1169
• 5 Kosters C, Schliemann B, Raschke MJ. [Tibial head fractures in the elderly]. Unfallchirurg 2011; 114: 251-260
• 6 Appleton P, Moran M, Houshian S. et al. Distal femoral fractures treated by hinged total knee replacement in elderly patients. J Bone Joint Surg Br 2006; 88: 1065-1070
• 7 Malviya A, Reed MR, Partington PF. Acute primary total knee arthroplasty for peri-articular knee fractures in patients over 65 years of age. Injury 2011; 42: 1368-1371
• 8 Parratte S, Bonnevialle P, Pietu G. et al. Primary total knee arthroplasty in the management of epiphyseal fracture around the knee. Orthop Traumatol Surg Res 2011; 97: S87-594
• 9 Kilian U. [Total knee replacement for primary treatment of intra-articular tibial head fractures in elderly patients]. Unfallchirurg 2003; 106: 1046-1050
• 10 Chen F, Li R, Lall A. et al. Primary total knee arthroplasty for distal femur fractures: a systematic review of indications, implants, techniques, and results. Am J Orthop (Belle Mead NJ) 2017; 46: E163-E171
• 11 Huang JF, Shen JJ, Chen JJ. et al. Primary total knee arthroplasty for elderly complex tibial plateau fractures. Acta Orthop Traumatol Turc 2016; 50: 702-705
• 12 Kini SG, Sathappan SS. Role of navigated total knee arthroplasty for acute tibial fractures in the elderly. Arch Orthop Trauma Surg 2013; 133: 1149-1154
• 13 Schwarz N, Buchinger W, Mahring M. et al. [Trauma hospital. Knee arthroplasty as primary therapy for proximal tibial fracture]. Unfallchirurg 2008; 111: 928-932
• 14 Su EP, Westrich GH, Rana AJ. et al. Operative treatment of tibial plateau fractures in patients older than 55 years. Clin Orthop Relat Res 2004; (421) 240-248
• 15 Ali AM, El-Shafie M, Willett KM. Failure of fixation of tibial plateau fractures. J Orthop Trauma 2002; 16: 323-329
• 16 Roerdink WH, Oskam J, Vierhout PA. Arthroscopically assisted osteosynthesis of tibial plateau fractures in patients older than 55 years. Arthroscopy 2001; 17: 826-831
• 17 Saleh KJ, Sherman P, Katkin P. et al. Total knee arthroplasty after open reduction and internal fixation of fractures of the tibial plateau: a minimum five-year follow-up study. J Bone Joint Surg Am 2001; 83: 1144-1148
• 18 Benazzo F, Rossi SM, Ghiara M. et al. Total knee replacement in acute and chronic traumatic events. Injury 2014; 45 (Suppl. 06) S98-S104
• 19 Weber O, Goost H, Mueller M. et al. [Mid-term results after post-traumatic knee joint replacement in elderly patients]. Z Orthop Unfall 2011; 149: 166-172
• 20 Softness KA, Murray RS, Evans BG. Total knee arthroplasty and fractures of the tibial plateau. World J Orthop 2017; 8: 107-114
• 21 Shauver MJ, Chung KC. Applying economic principles to outcomes analysis. Clin Plast Surg 2013; 40: 281-285
• 22 Majumdar SR, Lier DA, Hanley DA. et al. Economic evaluation of a population-based osteoporosis intervention for outpatients with non-traumatic non-hip fractures: the “Catch a Break” 1i [type C] FLS. Osteoporos Int 2017; 28: 1965-1977
• 23 Müller M, Trampuz A, Winkler T. et al. [The economic challenge of centralised treatment of patients with periprosthetic infections]. Z Orthop Unfall 2018;
• 24 Fehringer M, Münzberg M, Grützner PA. et al. [Periprosthetic fractures of the knee joint]. Z Orthop Unfall 2012; 150: e143-e153
• 25 Schreiner AJ, Gonser C, Ihle C. et al. Adverse events in the treatment of periprosthetic fractures around the knee – a clinical and radiological outcome analysis. Z Orthop Unfall 2018; 156: 287-297
• 26 Trieb K, Fialka C. [Periprosthetic femoral fractures: classification and therapy]. Z Orthop Unfall 2016; 154: 639-653
• 27 Schreiner AJ, de Zwart PM, Arnscheidt C. et al. [Implantation of a modular distal femoral replacement with compressive osseointegration as a salvage procedure in a complex femoral posttraumatic setting]. Z Orthop Unfall 2018; 156: 200-204