Description
Chloe Scott presents a detailed overview of arthroplasty for fractures around the knee, specifically targeting older adults. Emphasizing her role as a presenter from the Royal Edinburgh Hospital, she discusses the current practices and limitations in managing fractures such as distal femoral and tibial plateau fractures among the elderly population.
The presentation begins with the disclosure of the audience's understanding of weight-bearing protocols following fracture fixation. Despite advancements in fixation quality, less than half of surgeons allow unrestricted weight-bearing for distal femoral fractures, and only 14% do so for tibial plateau fractures. Scott highlights the cautious approach of many surgeons and suggests there is ample room for improvement in these protocols.
Scott analyzes the increasing prevalence of distal femoral fractures in the frail elderly, correlating their mortality rates to those of hip fractures. The use of distal femoral replacements is on the rise; however, there's an acknowledgment of the significant risks involved, including a 10-12% failure rate due to aseptic loosening and infection. This suggests a need for careful consideration when opting for this procedure in older patients.
The presentation also delves into the often-overlooked potential for immediate knee arthroplasty for tibial plateau fractures, arguing for a paradigm shift in treating older adults with pre-existing osteoarthritis. Scott emphasizes the health-related quality of life impacts of plateau fractures and the shortcomings of delaying knee replacements, thus questioning established practices that deem total knee replacements as "forbidden" for this demographic.
Ultimately, Chloe advocates for a modernized approach that considers knee arthroplasty as a viable and potentially beneficial option during the initial surgical intervention for certain populations, particularly those with severe joint depression or underlying osteoarthritis. She concludes by encouraging further discussions among orthopedic surgeons regarding these evolving surgical strategies as pathways to better patient outcomes.