Total knee arthroplasty for distal femoral fractures in osteoporotic bone

a systematic literature review

Sriskandarsara Senthilkumaran, David Robert Walker MacDonald (Corresponding Author), Iain Rankin, Iain Stevenson

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose
Distal femoral fractures in the elderly are associated with high morbidity and mortality and their incidence is increasing with an ageing population. Management of these fractures has evolved over recent decades and there is now an accepted recognition of the important role that acute arthroplasty may have in treatment of these fractures. Our purpose was to systematically review the evidence available in the literature for arthroplasty as a treatment option for distal femoral fractures.

Methods
This systematic review was conducted in accordance with the PRISMA reporting guidelines. We searched CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded (until October 2018) for studies and case series. Furthermore, clinical trial registries were searched for ongoing studies. We included all studies or case series that described total knee arthroplasty for distal femoral fractures irrespective of language, publication status, sample size, or follow-up period due to limited studies available in the literature. Exclusion criteria included single patient case reports, isolated tibia fractures, and periprosthetic fractures. Two authors independently identified trials for inclusion and independently extracted the data. Outcome measures included mortality, peri-operative complications (excluding mortality), anaesthetic time, blood loss, time to mobilisation, length of hospital stay, functional scores, radiological loosening, and revision rate.

Results
Fourteen papers were included for subsequent quantitative and qualitative synthesis incorporating a total of 181 patients. The highest level of evidence identified was a single cohort study (level III), the remaining 13 papers consisted of multi- or single-centre case series (level IV). The mean mortality rate was 3.34% (range 0–10) at 30 days and 18.4% (range 0–42) at 1 year. The mean revision rate was 3.43% (range 0–25) at 1 year. The mean time to mobilisation was 3.90 days (range 2.5–6) with a mean time to discharge from the acute ward being 16.6 days (range 8–33).

Conclusions
Although there is limited evidence in the literature available, our review suggests that there is a role for acute knee arthroplasty in distal femoral fractures. This mode of treatment has satisfactory mortality and revision rates, and may result in faster time to mobilisation and discharge. There is a need for a higher level of evidence to delineate this issue further.
Original languageEnglish
JournalEuropean Journal of Trauma and Emergency Surgery
Early online date28 Feb 2019
DOIs
Publication statusE-pub ahead of print - 28 Feb 2019

Fingerprint

Knee Replacement Arthroplasties
Femoral Fractures
Bone and Bones
Mortality
Arthroplasty
Length of Stay
Periprosthetic Fractures
Tibia
MEDLINE
Sample Size
Registries
Anesthetics
Publications
Cohort Studies
Language
Therapeutics
Outcome Assessment (Health Care)
Clinical Trials
Guidelines
Morbidity

Keywords

  • total knee arthroplasty
  • fracture fixation
  • distal femoral fractures
  • femoral fractures
  • periarticular fractures
  • trauma
  • Total knee arthroplasty
  • Distal femoral fractures
  • Fracture fixation
  • Femoral fractures
  • Periarticular fractures
  • Trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Total knee arthroplasty for distal femoral fractures in osteoporotic bone : a systematic literature review . / Senthilkumaran, Sriskandarsara ; MacDonald, David Robert Walker (Corresponding Author); Rankin, Iain; Stevenson, Iain.

In: European Journal of Trauma and Emergency Surgery, 28.02.2019.

Research output: Contribution to journalArticle

Senthilkumaran, Sriskandarsara ; MacDonald, David Robert Walker ; Rankin, Iain ; Stevenson, Iain. / Total knee arthroplasty for distal femoral fractures in osteoporotic bone : a systematic literature review . In: European Journal of Trauma and Emergency Surgery. 2019.
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abstract = "PurposeDistal femoral fractures in the elderly are associated with high morbidity and mortality and their incidence is increasing with an ageing population. Management of these fractures has evolved over recent decades and there is now an accepted recognition of the important role that acute arthroplasty may have in treatment of these fractures. Our purpose was to systematically review the evidence available in the literature for arthroplasty as a treatment option for distal femoral fractures.MethodsThis systematic review was conducted in accordance with the PRISMA reporting guidelines. We searched CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded (until October 2018) for studies and case series. Furthermore, clinical trial registries were searched for ongoing studies. We included all studies or case series that described total knee arthroplasty for distal femoral fractures irrespective of language, publication status, sample size, or follow-up period due to limited studies available in the literature. Exclusion criteria included single patient case reports, isolated tibia fractures, and periprosthetic fractures. Two authors independently identified trials for inclusion and independently extracted the data. Outcome measures included mortality, peri-operative complications (excluding mortality), anaesthetic time, blood loss, time to mobilisation, length of hospital stay, functional scores, radiological loosening, and revision rate.ResultsFourteen papers were included for subsequent quantitative and qualitative synthesis incorporating a total of 181 patients. The highest level of evidence identified was a single cohort study (level III), the remaining 13 papers consisted of multi- or single-centre case series (level IV). The mean mortality rate was 3.34{\%} (range 0–10) at 30 days and 18.4{\%} (range 0–42) at 1 year. The mean revision rate was 3.43{\%} (range 0–25) at 1 year. The mean time to mobilisation was 3.90 days (range 2.5–6) with a mean time to discharge from the acute ward being 16.6 days (range 8–33).ConclusionsAlthough there is limited evidence in the literature available, our review suggests that there is a role for acute knee arthroplasty in distal femoral fractures. This mode of treatment has satisfactory mortality and revision rates, and may result in faster time to mobilisation and discharge. There is a need for a higher level of evidence to delineate this issue further.",
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AU - Stevenson, Iain

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N2 - PurposeDistal femoral fractures in the elderly are associated with high morbidity and mortality and their incidence is increasing with an ageing population. Management of these fractures has evolved over recent decades and there is now an accepted recognition of the important role that acute arthroplasty may have in treatment of these fractures. Our purpose was to systematically review the evidence available in the literature for arthroplasty as a treatment option for distal femoral fractures.MethodsThis systematic review was conducted in accordance with the PRISMA reporting guidelines. We searched CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded (until October 2018) for studies and case series. Furthermore, clinical trial registries were searched for ongoing studies. We included all studies or case series that described total knee arthroplasty for distal femoral fractures irrespective of language, publication status, sample size, or follow-up period due to limited studies available in the literature. Exclusion criteria included single patient case reports, isolated tibia fractures, and periprosthetic fractures. Two authors independently identified trials for inclusion and independently extracted the data. Outcome measures included mortality, peri-operative complications (excluding mortality), anaesthetic time, blood loss, time to mobilisation, length of hospital stay, functional scores, radiological loosening, and revision rate.ResultsFourteen papers were included for subsequent quantitative and qualitative synthesis incorporating a total of 181 patients. The highest level of evidence identified was a single cohort study (level III), the remaining 13 papers consisted of multi- or single-centre case series (level IV). The mean mortality rate was 3.34% (range 0–10) at 30 days and 18.4% (range 0–42) at 1 year. The mean revision rate was 3.43% (range 0–25) at 1 year. The mean time to mobilisation was 3.90 days (range 2.5–6) with a mean time to discharge from the acute ward being 16.6 days (range 8–33).ConclusionsAlthough there is limited evidence in the literature available, our review suggests that there is a role for acute knee arthroplasty in distal femoral fractures. This mode of treatment has satisfactory mortality and revision rates, and may result in faster time to mobilisation and discharge. There is a need for a higher level of evidence to delineate this issue further.

AB - PurposeDistal femoral fractures in the elderly are associated with high morbidity and mortality and their incidence is increasing with an ageing population. Management of these fractures has evolved over recent decades and there is now an accepted recognition of the important role that acute arthroplasty may have in treatment of these fractures. Our purpose was to systematically review the evidence available in the literature for arthroplasty as a treatment option for distal femoral fractures.MethodsThis systematic review was conducted in accordance with the PRISMA reporting guidelines. We searched CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded (until October 2018) for studies and case series. Furthermore, clinical trial registries were searched for ongoing studies. We included all studies or case series that described total knee arthroplasty for distal femoral fractures irrespective of language, publication status, sample size, or follow-up period due to limited studies available in the literature. Exclusion criteria included single patient case reports, isolated tibia fractures, and periprosthetic fractures. Two authors independently identified trials for inclusion and independently extracted the data. Outcome measures included mortality, peri-operative complications (excluding mortality), anaesthetic time, blood loss, time to mobilisation, length of hospital stay, functional scores, radiological loosening, and revision rate.ResultsFourteen papers were included for subsequent quantitative and qualitative synthesis incorporating a total of 181 patients. The highest level of evidence identified was a single cohort study (level III), the remaining 13 papers consisted of multi- or single-centre case series (level IV). The mean mortality rate was 3.34% (range 0–10) at 30 days and 18.4% (range 0–42) at 1 year. The mean revision rate was 3.43% (range 0–25) at 1 year. The mean time to mobilisation was 3.90 days (range 2.5–6) with a mean time to discharge from the acute ward being 16.6 days (range 8–33).ConclusionsAlthough there is limited evidence in the literature available, our review suggests that there is a role for acute knee arthroplasty in distal femoral fractures. This mode of treatment has satisfactory mortality and revision rates, and may result in faster time to mobilisation and discharge. There is a need for a higher level of evidence to delineate this issue further.

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