Understanding the Role of Total Knee Arthroplasty for Primary Treatment of Tibial Plateau Fracture: a Systematic Review of the Literature

Overview

Journal J Orthop Traumatol

Specialties Emergency Medicine
Orthopedics

Date 2020 May 27

PMID 32451839

Citations 7

Authors

Murray T Wong

Jonathan Bourget-Murray

Kelly Johnston

Nicholas M Desy

Affiliations

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Abstract

Background: Surgical fixation of tibial plateau fracture in elderly patients with open reduction and internal fixation (ORIF) provides inferior outcomes compared with younger patients. Primary total knee arthroplasty (TKA) may be of benefit in elderly patients with a combination of osteoporotic bone and metaphyseal comminution. However, there continues to be conflicting evidence on the use of TKA for primary treatment of tibial plateau fracture. This systematic review was performed to quantify the outcomes and perioperative complication rates of TKA for primary treatment of tibial plateau fracture.

Materials And Methods: A comprehensive search of MEDLINE, Embase, and PubMed databases from inception through March 2018 was performed in accordance with PRISMA guidelines. Two reviewers independently screened papers for inclusion and identified studies featuring perioperative complications and outcomes of primary TKA for tibial plateau fracture. Weighted means and standard deviations are presented for each outcome.

Results: Seven articles (105 patients) were eligible for inclusion. All-cause mortality was 4.75 ± 4.85%. The total complication rate was 15.2 ± 17.3%. Regarding outcomes, Knee Society scores were most commonly reported. The average Knee Society Knee Score was 85.6 ± 5.5, while the average Knee Society Function Score was 64.6 ± 13.7. Average range of motion at final follow-up was 107.5 ± 10.0°.

Conclusions: Primary TKA for select tibial plateau fractures has acceptable clinical outcomes but does not appear to be superior to ORIF. It may be appropriate to treat certain geriatric patients with TKA to allow for early mobilization and reduce the need for reoperation. Other factors may need to be considered in deciding the optimal treatment.

Level Of Evidence: Level III.

Citing Articles

Risk for total knee arthroplasty after tibial plateau fractures: a systematic review.

Haslhofer D, Kraml N, Winkler P, Gotterbarm T, Klasan A Knee Surg Sports Traumatol Arthrosc. 2023; 31(11):5145-5153.

PMID: 37792085 PMC: 10598098. DOI: 10.1007/s00167-023-07585-8.

Arthroscopic-assisted reduction and internal fixation for complex tibial plateau fracture: radiographic and clinical outcomes with 2- to 15-year follow-up.

Cheng Y, Yang C, Chang S, Weng C, Chiu C, Chan Y J Orthop Surg Res. 2023; 18(1):448.

PMID: 37349746 PMC: 10286469. DOI: 10.1186/s13018-023-03938-8.

Current concepts review. Management of proximal tibial fractures.

Gahr P, Kopf S, Pauly S Front Surg. 2023; 10:1138274.

PMID: 37035564 PMC: 10076678. DOI: 10.3389/fsurg.2023.1138274.

The use of a metaphyseal sleeve total knee replacement as primary treatment for Schaztker VI tibial plateau fracture.

McSorley M, Jabbal M, Walmsley P J Surg Case Rep. 2022; 2022(12):rjac561.

PMID: 36570549 PMC: 9769953. DOI: 10.1093/jscr/rjac561.

[Change in the treatment of tibial plateau fractures].

Krause M, Frosch K Unfallchirurgie (Heidelb). 2022; 125(7):527-534.

PMID: 35380266 DOI: 10.1007/s00113-022-01165-0.

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