Tibial plateau fractures in older adults are associated with a clinically significant deterioration in health-related quality of life

Abstract

AimsTo investigate health-related quality of life (HRQoL) of older adults (aged ≥ 60 years) after tibial plateau fracture (TPF) compared to preinjury and population matched values, and what aspects of treatment were most important to patients.MethodsWe undertook a retrospective, case-control study of 67 patients at mean 3.5 years (SD 1.3; 1.3 to 6.1) after TPF (47 patients underwent fixation, and 20 nonoperative management). Patients completed EuroQol five-dimension three-level (EQ-5D-3L) questionnaire, Lower Limb Function Scale (LEFS), and Oxford Knee Scores (OKS) for current and recalled prefracture status. Propensity score matching for age, sex, and deprivation in a 1:5 ratio was performed using patient level data from the Health Survey for England to obtain a control group for HRQoL comparison. The primary outcome was the difference in actual (TPF cohort) and expected (matched control) EQ-5D-3L score after TPF.ResultsTPF patients had a significantly worse EQ-5D-3L utility (mean difference (MD) 0.09, 95% confidence interval (CI) 0.00 to 0.16; p < 0.001) following their injury compared to matched controls, and had a significant deterioration (MD 0.140, 95% CI 0 to 0.309; p < 0.001) relative to their preoperative status. TPF patients had significantly greater pre-fracture EQ-5D-3L scores compared to controls (p = 0.003), specifically in mobility and pain/discomfort domains. A decline in EQ-5D-3L greater than the minimal important change of 0.105 was present in 36/67 TPF patients (53.7%). Following TPF, OKS (MD -7; interquartile range (IQR) -1 to -15) and LEFS (MD -10; IQR -2 to -26) declined significantly (p < 0.001) from pre-fracture levels. Of the 12 elements of fracture care assessed, the most important to patients were getting back to their own home, having a stable knee, and returning to normal function.ConclusionTPFs in older adults were associated with a clinically significant deterioration in HRQoL compared to preinjury level and age, sex, and deprivation matched controls for both undisplaced fractures managed nonoperatively and displaced or unstable fractures managed with internal fixation.Cite this article: Bone Jt Open 2023;4(4):273–282.

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

“…Rates of TKA after TPF in older patients may therefore be falsely reassuring -patientreported outcome measures would provide more information. 17 The vast majority of older adults with TPFs do well following fracture fixation. Getting it right first time is paramount in older adults where immobility can be devastating and patients may not be fit enough for secondary surgery.…”

“…Rates of TKA after TPF in older patients may therefore be falsely reassuring – patient-reported outcome measures would provide more information. 17…”

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

“…While this does not necessarily infer significant symptoms, among older adults, it is possible that a number of patients do not undergo late TKA due to frailty or comorbidities rather than an absence of clinical symptoms. Rates of TKA after TPF in older patients may therefore be falsely reassuring; patient-reported outcome measures would provide more information [ 24 ].…”