Background

A 65-year old known rheumatoid female patient presented with severe pain in the left knee, difficulty in walking and performing daily activities. Clinical examination revealed severe osteoarthritis of the knees. She consulted several surgeons who advised total knee replacement.

Diagnosis and Treatment

She had been further investigated with X-ray of the knee joint that showed significant osteoarthritis with severe osteoporosis. As the pain did not correlate with the x-ray, she was further investigated with a CT scan of the knee. This revealed an osteoporotic intra-articular fracture of the distal femur with significant osteoarthritis of the knee joint. Hence, she was planned for a distal femoral replacement instead of a TKR. The patient was mobilized and was started on bisphosphonates before discharge. Full weight-bearing was achieved in 04 weeks. Further follow-up showed pain-free walking and knee flexion up to 120^o.

Conclusion

Distal femoral replacement is a very rarely performed surgery for non-tumour cases, as 95% survivorship is up to 10-15yrs. This is a better option for elderly people with significant osteoarthritis and fracture of the distal end of the femur or peri prosthetic fractures with severe osteoporosis, as mobilisation can be quicker and we can avoid the morbidities associated with prolonged bed rest. Hence arthroplasties should be individualised upon patient factors.

After implantation

About Author –

Dr. Sunil Dachepalli, Consultant Orthopedic Joint replacement & Arthroscopic Surgeon, Yashoda Hospitals – Hyderabad
MS ( Ortho), MBBS, MRCS, CCBST, MSc (Tr & Ortho), MCH (Ortho), FRCS ( Tr & Ortho)