Wui Ng Bing, Ahmad Anuar Muhammad Afiq, Abdul Wahid Abdul Muttalib
Orthopaedic Department, Hospital Segamat, Ministry of Health Malaysia, Johor, Malaysia.
Malays J Med Sci. 2020 Jul;27(4):64-71. doi: 10.21315/mjms2020.27.4.6. Epub 2020 Aug 19.
The management of fractures around the knee in the elderly population can be challenging due to the complexity of the patients and the fracture characteristics. In this study, we aimed to investigate the short-term outcome of elderly patients who had fractures around the knee and who were treated with primary total knee arthroplasty. The study included patients who were at least 70 years old with poor bone quality and who presented with a fracture around the knee that would be difficult to treat with open reduction and internal fixation (ORIF) as well as patients who were at least 55 years old presenting with severe concomitant knee osteoarthritis.
This is a cross-sectional study in which all the elderly patients who underwent early primary total knee replacement due to trauma around the knee at the Segamat Hospital between January 2015 and June 2019 were identified. Data were collected from clinical and operative notes. The clinical outcomes of these patients were evaluated by the range of motion of the knee and the Knee Society Score (KSS).
Ten patients were identified to have undergone this procedure. Six patients sustained supracondylar femur fractures, two patients had tibial plateau fractures and two patients had concurrent supracondylar femur and tibial plateau fractures. The mean follow-up duration was 22.3 ± 13.9 months, the mean knee score was 87.7 ± 10.0 and the mean functional knee score was 56 ± 41.9.
In this cohort, good short-term outcomes close to pre-fracture condition was noted in patients who did not suffer from any complications during the post-operative period. Two patients who had surgical site infection had lower functional knee scores. Another two patients with lower knee scores experienced surgical site infection of the distal tibia and contralateral fixed flexion deformity of the knee. Early primary total knee replacement remains a viable option in treating fractures around the knee in the elderly. Infection, which in this study affected 20% of the patients, is the main deterring factor in performing this procedure.
由于患者情况复杂以及骨折特点，老年人群膝关节周围骨折的治疗具有挑战性。在本研究中，我们旨在调查接受初次全膝关节置换术治疗的膝关节周围骨折老年患者的短期结局。该研究纳入了年龄至少70岁、骨质较差且膝关节周围骨折难以采用切开复位内固定术（ORIF）治疗的患者，以及年龄至少55岁且伴有严重膝关节骨关节炎的患者。
这是一项横断面研究，确定了2015年1月至2019年6月期间在昔加末医院因膝关节周围创伤接受早期初次全膝关节置换术的所有老年患者。从临床和手术记录中收集数据。通过膝关节活动范围和膝关节协会评分（KSS）评估这些患者的临床结局。
确定有10名患者接受了该手术。6名患者发生股骨髁上骨折，2名患者发生胫骨平台骨折，2名患者同时发生股骨髁上和胫骨平台骨折。平均随访时间为22.3±13.9个月，平均膝关节评分为87.7±10.0，平均膝关节功能评分为56±41.9。
在该队列中，术后未出现任何并发症的患者短期结局良好，接近骨折前状态。两名发生手术部位感染的患者膝关节功能评分较低。另外两名膝关节评分较低的患者发生了胫骨远端手术部位感染和对侧膝关节固定性屈曲畸形。早期初次全膝关节置换术仍是治疗老年患者膝关节周围骨折的可行选择。在本研究中，感染影响了20%的患者，是进行该手术的主要阻碍因素。
