Elderly patients see quicker mobilization with TKA after supracondylar fracture

Compared to internal fixation, however, TKA yields slightly lower functional score in these patients.

Elderly patients with supracondylar fractures walk independently sooner after total knee arthroplasty than after the gold-standard of open reduction internal fixation, according to a study.

"Our main objective in this challenging group of patients is obtaining early ambulation and a stable, painless, weight-bearing limb," said Eyiyemi O. Pearse, MA(Oxon), FRCS(Orth).

Pearse and colleagues compared the short-term and mid-term outcome measures of elderly patients who underwent open reduction internal fixation (ORIF) and those who underwent constrained total knee arthroplasty (TKA). Pearse presented the results at the 8th European Federation of National Associations of Orthopaedics and Traumatology Congress.

The retrospective study included 10 patients aged 75 years or older who were healthy and walked independently before injury, and who survived to time of discharge.

The researchers enrolled four patients in the ORIF group. All had AO/Muller Type A fractures; three received dynamic compression screws and one received a nail.

Six patients were enrolled in the TKA group, including two Type A fractures and four Type C, all of whom were treated with the Stanmore TKR [Biomet], Pearse said.

"Mean postoperative stay was shorter in the [TKA] group, and a greater proportion of patients (three of six) was discharged back to their own homes and independent living after [TKA] than after internal fixation (one of four)," Pearse said.

Mid-term follow-up averaged 26 months in the ORIF group and 33 months in the TKA group. One patient in the ORIF group died before follow-up.

In the TKA group, patients returned to walking at an average of 3.3 days, compared to an average of 9.5 days for the ORIF group.

"It took 10 days to achieve independent walking on average in the arthroplasty group, and only two of four patients achieved independent walking in the ORIF group, and this occurred in 19 days," Pearse said.

All three patients treated with ORIF were satisfied or pleased at follow-up. Five of the six patients who underwent TKA were satisfied or pleased. The one disappointed patient was the youngest enrolled in the study, being 76 years of age, according to Pearse.

Average knee flexion was similar between the two groups at follow-up, but the Oxford Hip Score appeared to be slightly better in the ORIF group: 28 vs. 33 points. However, Pearse noted that this score included only two of the ORIF patients because two patients never walked.

For more information:
Eyiyemi O. Pearse, MA (Oxon), FRCS (Orth), Consultant Orthopaedic Surgeon, can be reached at St. George's Hospital, Blackshaw Rd., London SW17 0QT; e-mail: yemipearse@aol.com. He has no financial conflicts to disclose.
Pearse EO. Symposium 15: Total prosthesis as a primary treatment of fractures of the knee and elbow — TKA vs. ORIF. Presented at the 8th European Federation of National Associations of Orthopaedics and Traumatology Congress. May 11-15, 2007. Florence, Italy.
Pearse EO, Klass B, Bendall SP, Railton GT. Stanmore total knee replacement vs. internal fixation for supracondylar fractures of the distal femur in elderly patients. Injury. 2005;36(1):163-168.