Total knee arthroplasty and fractures of the tibial plateau

Softness, Kenneth; Murray, Ryan S.; Evans, Brian G.

doi:10.5312/wjo.v8.i2.107

Cited by 51 publications

(48 citation statements)

References 28 publications

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“…1,2 For those treated surgically, treatment goals include restoring the articular surface plateau width and mechanical axes while achieving stable fixation to allow for early range of motion. [3][4][5] Despite these strategies, the longterm outcomes remain guarded for tibial plateau fractures: up to 45% of patients may develop posttraumatic arthritis (PTOA). [6][7][8] Traditional treatment options for patients with PTOA include osteotomy, arthrodesis, and total knee arthroplasty (TKA); however, in the majority of patients with end-stage osteoarthritis TKA is the primary option.…”

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confidence: 99%

Total Knee Arthroplasty versus Osteochondral Allograft: Prevalence and Risk Factors following Tibial Plateau Fractures

et al. 2018

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Orthopaedic surgeons commonly have the misconception that patients with tibial plateau fractures will likely go on to posttraumatic knee arthritis requiring total knee arthroplasty (TKA). In younger patients, osteochondral allograft (OCA) transplantation is an alternative method to address posttraumatic knee arthritis. The purpose of this study was (1) to identify our institutional failure rate following tibial plateau open reduction and internal fixation (ORIF) (failure was defined as conversion to TKA or OCA); (2) to determine if there are patient- or injury-related risk factors predictive of failure; and (3) to characterize differences between patients treated with TKA versus those treated with OCA transplantation. A 10-year retrospective review was conducted to identify patients treated at our institution with a tibial plateau fracture. Patients included in the final analysis were at least 18 years of age with an articular fracture (AO/OTA 41 B/C). The primary outcome was subsequent ipsilateral OCA or TKA. There were 350 patients (359 tibial plateau fractures) with a mean follow-up of 22.3 months (range, 6-133 months) who met inclusion criteria. Twenty-seven fractures (7.5%) were subsequently converted to a TKA or OCA at an average of 3.75 ± 3.1 years following their initial surgery. Patients who consumed tobacco were 2.3 times more likely to require a joint replacement (confidence interval [CI], 1.0-5.2; = 0.04). Those patients who received an OCAs were significantly younger as compared with their TKA peers, both at time of initial injury (37 vs. 51 years, = 0.02) and at time of surgery (41 vs. 55 years, = 0.009). The joint replacement rate in this study is similar to those studies in the published literature that focused solely on the prevalence of conventional TKA. Tobacco is a risk factor for failure following tibial plateau ORIF. Patients who were treated with an OCA were younger at time of injury and failure.

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confidence: 99%

Total Knee Arthroplasty versus Osteochondral Allograft: Prevalence and Risk Factors following Tibial Plateau Fractures

et al. 2018

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“…In 1995, Biyani et al 14 reviewed outcomes of 32 patients older than 65 years Tibial plateau fractures commonly occur due to highenergy trauma; however, in the elderly, lower energy mechanisms are more likely to be the culprit. 4 Most commonly, these fractures occur secondary to high-energy mechanisms such as motor vehicle accidents, pedestrian versus automobile accidents, or following a fall from height. 3 This study lends credence to these findings given that 69.4% of patients presented via one of the aforementioned mechanisms.…”

Section: Discussionmentioning

confidence: 99%

“…However, the goals of surgical intervention remain the same: restoring the articular congruity, condylar width, and re-establishing limb mechanical alignment. [4][5][6]24 Absolute indications for surgical fixation of tibial plateau fractures include open injuries, compartment syndrome, and injuries with vascular disruption. Relative indications include articular step-off of !…”

Section: Discussionmentioning

confidence: 99%

Age-Related Variances in Patients with Tibial Plateau Fractures

2019

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Tibial plateau fractures account for approximately 8% of fractures in the elderly population. Treatment strategies in the elderly are similar to those for younger patients; however, practitioners must account for the elevated comorbidity burden in this population. To date, few studies have analyzed age-based outcomes in patients with tibial plateau fractures. Therefore, the purpose of this study was to determine age-related variances in demographics, fracture characteristics, mechanism of injury, and complications. A 10-year retrospective review was conducted to identify patients who received treatment for a tibial plateau fracture. There were 351 patients (360 tibial plateau fractures) who were identified and subsequently stratified according to their age at the time of injury. Patients were classified as elderly if they were 65 years of age or older at the time of injury; all other patients were included in the control cohort. These two cohorts were analyzed using bivariate analysis to isolate for age-related variations with respect to risk factors, mechanism of injury, and complications. There were 351 patients (360 tibial plateau fractures) with a median follow-up of 1.84 ± 2.44 years who met inclusion criteria. There were a greater proportion of women in the elderly cohort as compared with the younger cohort (60.0 vs. 43.4%, p = 0.06). Elderly patients were significantly more likely to present with diabetes (33.3 vs. 16.1%, p = 0.01) or osteoporosis (14.3 vs. 1.6%, p = 0.001). Younger patients were significantly more likely to require further surgery to address ligament (12.6 vs. 0%, p = 0.008), meniscus (20.9 vs. 7.1%, p = 0.036), or cartilage pathology (13.6 vs. 0%, p = 0.005). There was no difference in the arthroplasty conversion rate (4.8% elderly vs. 7.9% control, p = 0.755). While elderly patients presented with a greater comorbidity burden, they had equivalent or better short-term outcomes when compared with their younger peers when treated with open reduction and internal fixation (ORIF). Despite the recent interest in primary total knee arthroplasty for elderly patients with tibial plateau fractures, the results of this study suggest that elderly patients may respond well when treated with ORIF following a tibial plateau fracture.

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“…Sofern eine sekundäre Frakturdislokation bei der Bewertung der Komplikationen mit einbezogen wird, trat diese in der aktuellen Studie in 2 von 8 Fällen auf. Grundsätzlich gilt auch zu bedenken, dass nach primärer Frakturendoprothetik geringere Komplikationsraten als nach sekundärer Endoprothetik im Verlauf nach ORIF beschrieben werden [20].…”

Section: Medizinische Aspekteunclassified

Osteosynthesis or arthroplasty of fractures near the knee joint in geriatric patients – a clinical-economical comparison

2019

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Background The treatment of fractures of the tibial plateau or distal femur often represents a severe problem in geriatric patients. In particular, complex fracture types and concomitant severe osteoporosis are confronted with inferior results following internal fixation. Therefore, primary arthroplasty is increasingly propagated for such particular cases. Patients, Materials and Methods In 16 patients suffering from fractures of the distal femur or tibial plateau were treated either by internal fixation (n = 8) or primary arthroplasty (n = 8). The outcome of each case was retrospectively analysed according to clinical and economic criteria. Results In the investigated geriatric patients, primary arthroplasty was significantly superior to internal fixation regarding mobilisation and range of motion without being inferior in cost-effectiveness. Conclusion Compared to internal fixation, primary arthroplasty represents an efficient and cost-effective therapeutical option for the treatment of complex fractures of the distal femur or tibial plateau of the elderly patient.

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Total knee arthroplasty and fractures of the tibial plateau

Cited by 51 publications

References 28 publications

Total Knee Arthroplasty versus Osteochondral Allograft: Prevalence and Risk Factors following Tibial Plateau Fractures

Total Knee Arthroplasty versus Osteochondral Allograft: Prevalence and Risk Factors following Tibial Plateau Fractures

Age-Related Variances in Patients with Tibial Plateau Fractures

Osteosynthesis or arthroplasty of fractures near the knee joint in geriatric patients – a clinical-economical comparison

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