Abstract
Introduction
Post traumatic arthritis of the knee can be a conseguence of distal femur fracture and retained hardware can complicate any further surgical option including arthroplasty. Both staged surgical procedures to remove before the hardware or simultaneous procedure of arthroplasty and removal of hardware have been indicated with an increased risk of complications. Aim of this study is to present a consecutive series of TKA following distal femur fracture using a computer assisted technique without the removal of retained hardware assessing both the efficacy of navigation in managing these complex cases as “routinary” primary arthroplasties.
Material and Methods
A consecutive series of 16 patients treated with a computer assisted TKR following femoral fracture and with retained hardware were included in the study (group A). The interval between the fracture and operation averaged 5.8 years (range 1–12 years), the retained hardwares was an intramedullary nail in 6 cases, distal lateral plates in 7 cases and screws in 4 cases. All patients in group A were matched with a patient who had undergone to a computer assisted TKR using the same implant and software because of atraumatic knee arthritis in the same period (group B). Patients were matched in terms of age, gender, pre-operative range of motion, pre-operative arthritis severity according to Albaack classification, type and grade of deformity and implant features (cruciate retaining or sacrificing). There were 10 male and 6 female for each group, the mean pre-operative age was 64.3 years (range: 54–72) for the group A and 65.4 years (range: 53–74) for the group B. The mean pre-operative flexion was 85.5 degrees (range: 65–115) and 88.1 degrees (range: 70–115) for the post traumatic group and the matched group respectively.
Results
There were no statistical significant differences in surgical time, hospital staying, intra/post operative complications. Likewise at a mean follow-up of 47 months no statistically significant difference was seen for the Knee Society, Functional, GIUM and WOMAC scores between the 2 groups. Implant alignment was similar between the 2 groups with similar radiological parameters.
Conclusions
The results of this study demonstrated that knee arthritis following distal femoral fracture can be safely managed using computer assisted TKA without any need of hardware removal and obvious costs savings. The Authors achieved both same results and same complication rate of similar uncomplicated primary TKR.
