Total knee arthroplasty after complex tibial plateau fractures

Abstract

Total knee arthroplasty following complex fractures of the tibial plateau is considered a challenge for orthopaedic surgeons and clinical outcomes may vary. A total of 29 total knee replacements were performed after a tibial plateau fracture: 25 patients (16 women, 9 men; average age: 57 years; mean follow-up: 92 months) were available. We had two significative complications: one partial avulsion of the patellar tendon, conservatively treated by bracing, and one case of deep venous thromboembolism, managed with low molecular weight heparin. In two cases (8%) there was a failure of the implant; nine cases were excellent, nine good, four fair and one poor. A percentage of patients with previous complex proximal tibia fractures had an increased rate of postoperative complications due to anatomical deformity, functional deficiency and post-traumatic arthritis and required solutions similar to revision surgery. Total knee arthroplasty is a suitable solution for the treatment of these challenging cases: compared to primary knee replacement, final KSS score is generally lower, but improvement is similar due to poorer pre-operative scores.

Total Knee Arthroplasty in Patients With a Prior Tibial Plateau Fracture: A Long-Term Report at 15 Years

“…There are few reports, with limited patient numbers and followup, on the mid-to longterm outcomes of TKA after fractures of the tibial plateau [6][7][8]. The purpose of the present study was to evaluate the long-term results of TKA after a prior tibial plateau fracture.…”

“…Severe intra-articular fractures, malunions, and nonunions all contribute to a higher risk of developing premature osteoarthritis [3][4][5]. The early onset of post-traumatic arthritis increases the likelihood of total knee arthroplasty (TKA) at a younger age [6,7]. Total knee arthroplasty following open reduction and internal fixation (ORIF) of a tibial plateau fracture presents unique challenges.…”

“…Questions include the degree to which ongoing complications occur and whether or not the anatomic and biologic features surrounding the previous fracture have a strong long-term effect on implant fixation. To date, there is a paucity of published literature on the mid-or long-term results of TKA after a prior tibial plateau fracture [6,8,10,11].…”

Impaction bone grafting has potential as an adjunct to the surgical stabilisation of osteoporotic tibial plateau fractures: Early results of a case series

“…In cases of TPF failure, a total knee arthroplasty (TKA) may be required [9], however these have high complication rates and poor outcomes [10][11][12][13], with revision rates of between 8% [13,14] and 40% [10] reported at short-to medium-term follow-up. Alternatively, acute TKA can be performed, but this commonly requires the use of stemmed hinged implants and has similar complication and Introduction: Osteoporotic tibial plateau fractures (TPFs) are difficult to treat with either open reduction internal fixation (ORIF) or acute total knee arthroplasty (TKA).…”

“…failure rates [14,15] to TKA performed after failed TPF [13]. Acute TKA has been suggested as a reasonable option in octogenarians [16], given their shorter life expectancy.…”