Abstract

Background

Treatment goals for pathologic fractures about the knee include pain relief and unrestricted weight bearing. In cases of condylar destruction, these fractures may not be amenable to internal fixation, and arthroplasty may be considered. The purpose of this study was to analyze the outcomes of knee arthroplasty for primary treatment of impending or pathologic fractures of the distal femur or proximal tibia.

Methods

Fifteen (8 males and 7 females) patients, mean age 62 ± nine years, undergoing arthroplasty for management of a pathologic peri-articular distal femur (n = 11) or proximal tibia (n = 4) fracture between 2001 and 2017 were reviewed. Implants included tumour endoprostheses (n = 11) and rotating hinged total knees (n = 4). Pathology included metastatic disease (n = 14) and lymphoma (n = 1). Eight (53%) patients presented with a fracture while the remainder had large impending lesions.

Results

Mean follow-up was 19 months. At final follow-up, 11 patients had died with overall five year survival of 33%. Two (13%) patients required re-operation; including wound irrigation and debridement (n = 1) and above knee amputation for local recurrence (n = 1). An additional two (13%) patients developed post-operative VTE. MSTS, KSS, and KSS-F scores improved from a mean 12 ± 16%, 30 ± 11, and 14 ± 24 pre-operatively to 69 ± 26%, 75 ± 16, and 67 ± 25 at final follow-up, respectively (P < 0.001). Thirteen (87%) patients had severe pain prior to surgery with no patients (0%, P < 0.001) reporting severe pain at last follow-up.

Conclusion

Knee arthroplasty provided improved function and full weight-bearing making it an effective treatment for pathologic periarticular fractures of the distal femur and proximal tibia.

中文翻译：

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膝关节置换术治疗股骨远端和胫骨近端的病理性关节周围骨折的结果

摘要

背景

膝关节病理性骨折的治疗目标包括缓解疼痛和不受限制的负重。在con突破坏的情况下，这些骨折可能不适合内部固定，可以考虑进行关节置换术。这项研究的目的是分析膝关节置换术对股骨远端或胫骨近端即将发生的或病理性骨折的主要治疗的结果。

方法

 回顾了2001年至2017年间接受手术治疗的15例（男8例，女7例），平均年龄62±9岁，接受了病理性关节周围股骨远端（n  = 11）或胫骨近端（n = 4）骨折的治疗。植入物包括肿瘤假体（n  = 11）和旋转铰接全膝（n  = 4）。病理学包括转移性疾病（n  = 14）和淋巴瘤（n  = 1）。八名（53％）患者出现了骨折，其余患者的病变即将发生。

结果

平均随访19个月。在最后的随访中，有11名患者死亡，五年总生存率为33％。2名（13％）患者需要再次手术；包括伤口冲洗和清创术（n  = 1）以及膝盖以上截肢的局部复发（n  = 1）。另外两名（13％）患者发生了术后VTE。MSTS，KSS和KSS-F评分从术前平均12±16％，30±11和14±24分别提高到最终随访时的69±26％，75±16和67±25 （P  <0.001）。十三名（87％）患者在手术前有严重疼痛，没有患者（0％，P  <0.001）在上次随访时出现严重疼痛。

结论

膝关节置换术改善了功能并充分承重，使其成为股骨远端和胫骨近端病理性关节周围骨折的有效治疗方法。