A matched cohort study of 31 total knee arthroplasties performed for post-traumatic osteoarthritis after tibial plateau fracture. Outcomes were compared against 93 age and gender-matched TKAs done for primary osteoarthritis. It asks whether prior plateau fracture worsens complication rates and patient-reported outcomes after knee replacement.
When you counsel a patient facing TKA after a healed plateau fracture, the honest message is: more complications, but the same functional destination.
Expect higher rates of wound problems, stiffness, and intra-operative soft-tissue injury, especially if they had ORIF. All wound complications in this series followed ORIF, so plan the arthroplasty incision to incorporate a prior longitudinal scar and avoid transverse ones where possible.
Mode of failure predicts timing. Instability and nonunion send patients to TKA within about a year, while malunion buys years before conversion. Older women with nonunion are a distinct high-risk subgroup.
The surgical mental model: this often behaves like a mild revision. Cruciate-retaining implants suffice in most cases, but be ready for a tibial tubercle osteotomy, an augmented stem, and management of AORI Grade I to II defects. Remember the plateau principle this reinforces: restoring the mechanical axis matters more than perfect articular reduction for long-term knee survival.
A matched cohort study of 31 total knee arthroplasties performed for post-traumatic osteoarthritis after tibial plateau fracture. Outcomes were compared against 93 age and gender-matched TKAs done for primary osteoarthritis. It asks whether prior plateau fracture worsens complication rates and patient-reported outcomes after knee replacement.
When you counsel a patient facing TKA after a healed plateau fracture, the honest message is: more complications, but the same functional destination.
Expect higher rates of wound problems, stiffness, and intra-operative soft-tissue injury, especially if they had ORIF. All wound complications in this series followed ORIF, so plan the arthroplasty incision to incorporate a prior longitudinal scar and avoid transverse ones where possible.
Mode of failure predicts timing. Instability and nonunion send patients to TKA within about a year, while malunion buys years before conversion. Older women with nonunion are a distinct high-risk subgroup.
The surgical mental model: this often behaves like a mild revision. Cruciate-retaining implants suffice in most cases, but be ready for a tibial tubercle osteotomy, an augmented stem, and management of AORI Grade I to II defects. Remember the plateau principle this reinforces: restoring the mechanical axis matters more than perfect articular reduction for long-term knee survival.