Case History: Female, 56y, with right total knee arthroplasty within 1 year postop. Presented in the ER with a fall from standing height with direct knee trauma.
Clinical findinds: Pain, sweeling and deformity, unable to move.
Results/ Diagnosis: X-Ray showed supra-intercondylar periprosthetic of the right femur, Lewis type III and Rorabeck.
Therapy and Progressions: The patient before the fall already had a history of mechanical pain and joint stiffness. The authors decided to do an arthroplasty revisiom with semi-restrictive prosthesis with femoral and tibial stems. The external condyle/external lateral ligament was fixed with an anchor and the internal condyle with 2 Kirschner wires. Complication-free post-operative. The patient followed a rehabilitation plan, according to the service"s protocol. At 2 months, gait whith 2 crutches, painless and arch of mobility 0º-90º. At 6 months, Walking without crutches, mobility arc of 0º-100º, KSS 90/100. Kirschner wires were removed due to complaints of pain on palpation of the medial condyle of the femur.
Comments: Revision arthroplasty is a valid option for the treatment of peri-prosthetic fractures in selected cases, especially when the aim is to restore function. The options considered were osteosynthesis with an LCP-type plate and revision prosthesis. We opted for the revision prosthesis due to the previous history of joint pain and stiffness, due to poor placement of the primary implant. The authors consider that, despite the technical difficulty and risks inherent to knee revision arthroplasty, in this particular case, it was the best option, both due to complaints before the trauma, as well as the characteristics of the fracture, saving the patient from other surgical interventions and inherent risks.
References: Ebraheim et al,2015; Cacciola et al, 2021; Kuzyk et al, 2017; Kamal et al, 2020
No