Primary Total Knee Arthroplasty (TKA) in Tibial Plateau Fractures

Abstract

Fifty percent of tibial plateau fractures occur in adult older than 50 years old, with 8-24 % of those occurring in elderly patients. The gold standard treatment for these fractures in young patients is open reduction and internal fi xation (ORIF). However, because of poor bone quality, soft tissue impairment, and complications related to immobilization, ORIF in the elderly are associated to a high complication rate. For this reason, some authors proposed early total knee arthroplasty (TKA) to treat tibial plateau fractures in elderly patients affected by prior osteoarthritis. Surgeons approaching this surgery should be aware that the outcomes are inferior compared to elective TKA. Furthermore, the complication rate following TKA in tibial plateau fractures are more similar to revision TKA than primary TKA. For these reasons, early arthroplasty in proximal tibial fractures should be reserved to elderly patients affected by prior osteoarthritis, who do not comply with the restricted weight-bearing postoperative protocol in order to avoid further surgery. There are few reports on literature reporting on the outcomes of early TKA in tibial plateau fractures, with small records and short follow-up. However, the authors agree in defi ning this procedure as a valid option in these patients.This chapter reviewed indications, surgical techniques, and outcomes of TKA to treat acute tibial plateau fracture.