Risk of total knee replacement after proximal tibia fracture: a register-based study of 7,841 patients

Abstract

Background and purpose — Post-traumatic knee osteoarthritis following proximal tibia fracture (PTF) is a common complication that may lead to total knee replacement as secondary treatment (TKRS). We determined the risk of TKRS following PTF, whether treated nonoperatively or operatively, and compared the results with a 38-fold control group without prior PTF. Patients and methods — We identified all patients over 18 years of age in Finland with PTF treated during the period 2009–2018 from the Finnish Hospital Discharge Register (FHDR) and Finnish Arthroplasty Register (FAR). Age, sex, treatment method, follow-up time, and possible TKRS were recorded. Results — 7,701 patients were treated for PTF during the period 2009–2018. Over the 5.1-year (SD 3.1) follow-up, TKRS was performed in 340 (4.3%) patients with a prior PTF after a mean of 2.1 (SD 2.0) years post-fracture. TKRS was needed in 138 (3.7%, HR 1.8) patients in the nonoperatively treated group and in 202 (5.0%, HR 3.2) patients in the operatively treated group. Operative treatment, female sex, and high age were identified as risk factors for TKRS. The incidence of TKRS was highest during the first 2 years after fracture and remained elevated throughout the follow-up. Interpretation — Patients with a prior PTF had a 1.8- to 3.2-fold higher risk of TKRS compared with controls during the first 5 years post-fracture. Risk of TKRS was associated with an operatively treated PTF, female sex, and high age. The patients in the operative group likely sustained more complex fractures, while female sex and age may be explained by more osteoporotic bone quality.

Tibial plateau fractures are associated with poor functional outcomes and a low conversion rate to total knee arthroplasty

“…This was statistically significant at the 2 years follow‐up and a tendency at 5‐, 7‐ and 10‐years follow‐up. Similar results were found in other publications [5, 8, 25, 29]. Higher age has a negative impact on the repair cells, extracellular matrix, blood supply and molecules and their receptors [15].…”

“…A recently published systematic review stated a conversion rate of about 5% [8]. The four largest studies in this review reported a percentage between 4.4% and 7.3% with a mean follow-up between 5.1 years and 13.9 years [5,25,28,29]. These values are slightly lower compared with our percentages and follow-up.…”

“…The highest risk was noted in the first years after the fracture. Different risk factors for TKA after TPF like female gender or higher age have been reported [2,5,22,25,26,29].…”

Current concepts review. Management of proximal tibial fractures

“…However, while radiographic signs of post-traumatic osteoarthritis after proximal tibial fracture are common, symptomatic osteoarthritis leading to total knee replacement is still a rare event. While the very low TKA conversion rate in earlier publications may be due to the limited experience with revision knee arthroplasty at that time ( 84 ), even recent studies report conversion rates below 10% at 5–10 years of follow-up ( 90 , 91 ). Although risk is thought to increase with age, geriatric patients generally do well with ORIF after tibial plateau fracture ( 90 , 92 , 93 ).…”

Risk of conversion to total knee arthroplasty after surgically treated tibial plateau fractures: an observational cohort study of 439 patients

“…Elsoe et al studied 7,950 TPFs, regardless of treatment, from the Danish Patient Register and found a 5.7% conversion rate to TKA with a mean follow-up of 13.9 years [ 11 ]. A Finnish hospital discharge register report found a conversion rate to TKA of 4.4% in 7,701 patients after TPF with a mean follow-up of 5.1 years [ 20 ]. The conversion rate was 5.0% in the surgically treated group.…”