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Table 3 Post-operative outcome

From: Intra-operative fractures in primary total knee arthroplasty - a systematic review

Study Revision surgery Clinical outcome Radiographic outcome Post-operative physiotherapy protocol
Alden et al. [2] 14 of the 66 patients (21%) underwent revision arthroplasty at an average of 2.8 years
Instability-4, loosening and osteolysis-4, infection-2, anterior knee pain-1, patellar mal-tracking-1, stiffness-1, progression of metastatic disease-1
Knee extension improved from 7.1° pre-operatively to 1.8° post-operatively. Knee flexion remained unchanged at 103°. Mean Knee Society score (KSS0 improved from 46.4 pre-operatively to 79.5 post-operatively. Mean KSS function score increased from 34.5 pre-operatively to 61 post-operatively All fractures healed radiographically Non-displaced fractures - touch weight bearing for 6 weeks
Agarwala et al. [4] No patients required revision surgery over the follow up The mean KSS pre-operatively was 35.7. Post-operatively, KSS at first follow up was 81 and AT last follow up was 92 All patients achieved bony union at a mean duration of 8.9 weeks (range 5–16 weeks) Full range of motion of the operated knee with full weight bearing using a walker
Pinaroli et al. [3] 1 with tibial tuberosity fracture at 3 months-ORIF
1 patient with femorotibial instability-liner exchange at 23 months
1 patient with complex metaphyseo-diaphyseal fracture required multiple operations including revision fixation and bone grafting, two-stage revision for infection
Tibial fractures-IKS score-88.2
Function score-72.8
Femoral fractures
IKS score-89.1
Function score-75.6
All fractures healed except one with complex tibia fracture which required multiple operations Stable femoral fractures-delayed weight bearing for 1–2 months
No report on tibial fractures
Hernigou et al . [8] NR NR NR NR
Delasotta et al. [7] None during the reported follow up Average range of motion-0 – 116°
Knee Injury and Osteoarthritis Outcome score-76.8 (64.3–91.7)
UCLA score-5 (4–6)
All fractures healed NR
Huang et al. [6] None Case 1-Knee Society and function scores were 70 and 65, respectively, at 2-year follow up
Case 2-Knee Society and function scores were 68 and 70, respectively, at 2-year follow up
Union confirmed at 3-month follow up
Union confirmed at 3 month follow-up
Active and passive ROM exercises implemented. A brace was used and partial weight bearing with a walker encouraged for the first 2 post-operative months
Pun et al. [5] One patient developed hematogenous infection secondary to an infected ingrown toenail and underwent revision TKA 9 months later. Mean KSS-89.7
Function score-73.2
All patients achieved bone union Patients were allowed full range of knee motion and full weight bearing with a walking frame on day 1. The walking frame was replaced by 2 crutches as patient mobility progressed. At 4 weeks, mobilization with one crutch or a single walking stick was allowed
Lombardi et al. [13] None IB-II PS knee-Pre-operative HSS score of average 55, average total postoperative score of 83
Maxim PS-average total pre-operative HSS score was 60, post-operative-81
All fractures healed No change from the usual protocol. Full weight bearing and range of motion
Berry et al. [12] NR NR NR NR
Felix et al. [9] 1 required revision at 3 months with hinged prosthesis. Initial intra-operative fracture through a cyst was treated with curettage and cement, which failed with loosening of the tibia component NR NR Non-weight bearing or partial weight bearing for 2 months
  1. NR not reported, ROM range of motion, TKA total knee arthroplasty