Primary and Secondary Total Knee Arthroplasty for Tibial Plateau Fractures

Abstract

The surgical management of tibial plateau fractures can be technically demanding. In younger patients, the mainstay is fixation with cartilage preservation. In older patients with osteoporotic bone, this method has higher rates of fixation failure; in addition, it requires prolonged bed rest or protected weight bearing, which are major challenges in this group. In contrast, total knee arthroplasty performed acutely for primary treatment of tibial plateau fractures has potential advantages for elderly patients, such as immediate stability, early mobilization, and positive functional outcomes with decreased rates of reoperation. Additionally, arthroplasty can be technically challenging in younger patients with previous tibial plateau fractures in whom debilitating posttraumatic arthritis develops. In these patients, old wounds, retained metalwork, bony deficiency, and instability can lead to poorer outcomes and higher complication rates than in routine knee arthroplasty. In both cases, we recommend surgery be performed by experienced arthroplasty surgeons with ample access to a range of implants with varying constraints and the option of stems and augments.

Management of Collapse Tibial Plateau Fractures Using a Hydroxyapatite-Tricalcium Phosphate Ceramic(ATLANTIK�) and Plate Osteosynthesis

“…Complex articular tibial plateau fractures are difficult to treat and they are associated with a high rate of complications [2,4]. In difficult cases, primary total knee arthroplasty has potential advantages for elderly patients, while it can be technically challenging in younger patients [42,43]. The management of bone defects associated with comminution and osteoporosis represents a great challenge in clinical practice [12,38,44].…”

Comparison of the Effectiveness and Safety of Intravenous and Topical Regimens of Tranexamic Acid in Complex Tibial Plateau Fracture: A Retrospective Study

“…The inclusion criteria were: (1) more than 18 years of age; (2) the presence of a unilateral closed tibial plateau fracture, image inspection that conformed to Schatzker and classi cation standards; (3) no coagulopathy or abnormal hemoglobin before the operation; (4) fresh fracture, with a period between injury to hospital admission of less than 3 days. The exclusion criteria were: (1) patients with severe brain, heart, liver, and kidney dysfunction who could not tolerate surgery; (2) patients with coagulation dysfunction; (3) patients with pathological fractures or tumors; (4) bilateral tibial plateau fractures or other injuries; (5) contraindications for the use of TXA or anticoagulant drugs;…”

Comparison of the effectiveness and safety of different regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

“…The inclusion criteria were: (1) more than 18 years of age; (2) the presence of a unilateral closed tibial plateau fracture, image inspection that conformed to Schatzker Ⅴ and Ⅵ classification standards; (3) no coagulopathy or abnormal hemoglobin before the operation; (4) fresh fracture, with a period between injury to hospital admission of less than 3 days; (5) and preoperative ultrasonography that shows deep vein thrombosis (DVT). The exclusion criteria were: (1) patients with severe brain, heart, liver, and kidney dysfunction who could not tolerate surgery; (2) patients with blood system diseases; (3) patients with pathological fractures or tumors; (4) bilateral tibial plateau fractures or other injuries; (5) contraindications for the use of TXA or anticoagulant drugs; (6) patients with incomplete data. In addition, if the surgeon chose to fill the collapsed articular surface with an autologous bone graft during surgery, the patient's data were also excluded from the statistical analysis, as it was considered that the extra wound incision and blood loss from the iliac bone may have affected the results.…”