Background: Non union of supracondylar fractures of the femur in old age patients is difficult to treat because of limited bone stock for fixation and marked osteoporosis of the distal fragments and if nonunion occur in osteoarthritic knee treatment will be more difficult and all methods of treatment associated with many complications.
Patients and methods We treat those patients by cemented rotating-hinge total knee replacement we have used the cemented, long-stemmed Endo-model rotating-hinge TKR (Waldemar Link GMBH & Co, Hamburg, Germany) , thirteen total knee replacement were done between 2002 and 2007 for 12 nonunited supracondylar fractures and one nonunited supracondylar osteotomy, The time interval between the fracture and performance of TKR ranged from 24 to 62 month, the mean age of the patients was 69 years (59 to 85). We were able to review the whole patients at a mean follow up of 50 months (35 to 92 months). We used the clinical rating system of the Hospital for Special Surgery and the clinical and radiological scoring systems of the Knee Society. For patellofemoral status we used the Outerbridge grading system and we used the scale of Stern and
Insall to assess anterior knee pain.
Results According to the clinical rating system of the Hospital for Special Surgery excellent results in two patients, good in six patients, fair in four patients and poor results in one patient, In nine patients, the knee flexion ranged from 70° to 110, three patients ranged from 30° to 60° in one patient, the knee flexion was only 20°.
Conclusion In summary, we have found the Endo-model rotating hinge knee replacement to be a good option for those elderly arthritic patients with fractures of the supracondylar femur that fail to unite with early weight bearing and expected good and excellent results for most of the patients
Key words nonunion - supracondylar femoral fractures - total knee replacement.
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