Acute Total Knee Arthroplasty for Unicondylar Tibial Plateau Fracture Using Metaphyseal Cones

Pre-existing knee osteoarthritis and severe joint depression are associated with the need for total knee arthroplasty after tibial plateau fracture in patients aged over 60 years

“…18 Where lateral augments are difficult to implant via a medial parapatellar approach for Schatzker II defects due to the patella tendon, metaphyseal fixation devices such as asymmetric cones 26-28 or sleeves 29 have made TPF defects much easier to manage at acute TKA. 18 Bicondylar Schatzker V and VI fractures can similarly be considered as AORI type 2b (uncontained affecting both plateaus) or type 3 (severe metaphyseal deficiency) defects, and may require long stem diaphyseal fixation in addition to metaphyseal augmentation if acute TKA is to be performed.…”

“…The ability to predict those at high risk of failure in order to potentially change their primary management is key. In contrast to younger patients where higher functional requirements and long-term survival preclude arthroplasty solutions, the role of TKA in the management of TPFs in older adults may be greater than has previously been explored, 18,19 similar to the experience in both elbow 20 and shoulder trauma. 21 Though pre-existing knee OA and unreconstructable depression in osteoporotic bone have previously been proposed as indications for acute TKA in TPF management, 22 the current study is the first to provide the evidence for such indications.…”

“…If considering acute TKA to manage these fractures, Schatzker II, III, and IV fractures can be considered Anderson Orthopaedic Research Institute (AORI) type 2a defects (uncontained defect in a single plateau) 25 that can be managed acutely with metaphyseal fixation using cones, sleeves, or augments. 18 Where lateral augments are difficult to implant via a medial parapatellar approach for Schatzker II defects due to the patella tendon, metaphyseal fixation devices such as asymmetric cones 26-28 or sleeves 29 have made TPF defects much easier to manage at acute TKA. 18 Bicondylar Schatzker V and VI fractures can similarly be considered as AORI type 2b (uncontained affecting both plateaus) or type 3 (severe metaphyseal deficiency) defects, and may require long stem diaphyseal fixation in addition to metaphyseal augmentation if acute TKA is to be performed.…”