Computer Navigation-assisted Bilateral Total Knee Arthroplasty with Osteosynthesis in Single Sitting in Patients Presenting with Distal Femur Fracture with Pre-existing Knee Arthritis: A Case Series.

BACKGROUND: Intra-articular and periarticular distal femur fractures with pre-existing osteoporosis (OP) and osteoarthritis (OA) pose a significant challenge to ambulatory patients because of the higher chances of implant failure and severe disability of OA. To reduce OA-related morbidity, we advocate simultaneous total knee arthroplasty (TKA) with fracture fixation instead of fracture fixation alone using computer-assisted navigation to achieve proper ligament balance, restoration of the mechanical axis, and component alignment.

CASE REPORT: A case series of four patients (male - 2 and females - 2) with periarticular fractures of the distal femur with severe OA and OP were primarily fixed with different modalities such as distal femur locking plates, cannulated-cancellous screw, and Herbert screw followed by computer navigation-assisted cruciate retaining TKA. All patients had Kellgren Lawrence grade ≥3 OA and underwent bilateral TKA. All patients were aggressively treated for OP using pulsed PTH therapy. Patients were found to have a faster recovery with the initiation of early partial weight bearing with crutches postoperatively in all patients, followed by unassisted weight bearing once radiological union was seen.

CONCLUSION: Based on satisfactory quality evidence and navigation-assisted cruciate-retaining TKA appears to be a useful treatment option for distal femoral fractures with pre-existing OA and OP. This is cost-effective and is associated with the least morbidity and excellent patient satisfaction.