Abstract
Purpose: Total knee arthroplasty is an effective treatment for arthritis, even in post-traumatic situations. However, the final results in this specific etiology are poorer than in degenerative cases. Difficulties come from intra-articular involvement of the initial fracture leading to articular bone defects, joint stiffness, capsula and ligaments retraction, various previous skin incisions with wound complications, and younger more demanding patients. Even the knee artrhoplasty device may be different from degenerative situation.
Material and Methods: We report a retrospective series of 11 knee prostheses implanted from 1995 to 2007 in post-traumatic cases with intra-articular malunion due to the initial fracture. Review of the procedures included type of previous incisions, number and type of flap coverage, amount of articular release, specific knee artrhoplasties (hinged or postero-stabilized), and final outcome based on IKS score.
Results: In all cases but one, the prosthesis gave a better result on mobility compared to pre-op function. Pain relief was obtained in all cases. In one case, removal of the prosthesis was needed due to infection. In 8 cases, flap coverage was done previously or simultaneously to arthroplasty implantation. Technical tricks are emphasized based on complications listed.
Discussion: Results of total knee arthropplasty in post-traumatic cases are poorer than in degenerative situations. Additional techniques are mandatory such as bone graft, flap coverage, and extensive articular release. Computer assisted surgery is helpful in severe angular deformity or complex post-trauma ‘anatomy’.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Email: office@efort.org
