Features and Results of Knee Arthroplasty after Knee Fractures Fixation

Abstract

The purpose of the study to assess the results and risk of complications of primary total knee arthroplasty in patients with a history of osteosynthesis of intra-articular fractures. Materials and Methods. Our study integrates the retrospective and prospective analysis of the results of primary total knee arthroplasty (TKA) performed in 140 patients, in period from 2015 to 2019. The retrospective part of the study included the arthroplasty results of 100 patients, prospective 40 patients. Each of the groups was divided into 2 subgroups: with previous osteosynthesis (MOS) of intra-articular fractures before arthroplasty and without history of knee surgery before arthroplasty. To assess the results of TKA, adapted to Russian-language versions of the KSS, WOMAC and FJS-12 scales were used. The X-ray of the endoprosthesis components positioning was assessed using the KRESS scale. Results. Statistically significant differences were found between retrospective groups with MOS and without it in the duration of the surgery, in the volume of intraoperative blood loss, in the higher frequency for implantation of the endoprosthesis systems with an increased degree of coupling of the components. The rate of postoperative complications was higher in retrospective group MOS. Mid-term functional results did not show statistically significant differences on the KSS and WOMAC scales, patient satisfaction rates on the FJS-12 scale were worse in retrospective group MOS. Prospective group of patients with a history of MOS for intraarticular fractures demonstrated statistically significant increase of the knee ROM from 89 to 108, after the TKA. The function recovery dynamics according to the KSS, WOMAC and FJS-12 was slowed down at 3 and 6 months, and according to the WOMAC and FJS-12 scales, even after 12 months post-operation. Conclusion. The previous trauma and knee intra-articular fractures fixation leads to an earlier development of post-traumatic osteoarthritis. Functional results in the retrospective and prospective groups do not have statistically significant differences. The number of postoperative complications is greater in the retrospective groups. MOS in the history statistically significantly slows down the dynamics of function recovery in the early postoperative period.