Weiss, J Bone Joint Surg Am 2003 - Total Knee Arthroplasty in Patients with a Prior Fracture of the Tibial Plateau

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Total Knee Arthroplasty in Patients with a Prior Fracture of the Tibial Plateau

Weiss, Lewallen, et al.·J Bone Joint Surg Am·2003·169 citations·Case series

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Background

A fracture of the tibial plateau may predispose the knee to the development of posttraumatic arthritis. Malunion, intra-articular chondro-osseous defects, limb malalignment, retained internal fixation devices, and poor surrounding soft tissues may in turn compromise the outcome of total knee arthroplasty. The aim of our study was to evaluate the results of total knee arthroplasty in patients with a previous fracture of the tibial plateau.

Methods

The results of 62 condylar total knee arthroplasties performed with cement, from 1988 to 1999, in 62 patients with a previous fracture of the tibial plateau were reviewed.
The fracture of the tibial plateau had been treated by open reduction and internal fixation in 38 knees, external fixation in one knee, and nonoperatively in 23 knees.
There were 40 women and 22 men with an average age of 63 years at the time of the arthroplasty.
Knee Society scores were recorded preoperatively and at the time of follow-up, at an average of 4.7 years, and complications were noted.
No patient was lost to follow-up.

Results

The mean Knee Society scores improved significantly (p < 0.0001), from 43.9 points for pain and 52 points for function preoperatively to 82.9 and 84 points, respectively, at the time of the latest follow-up.
There were 13 reoperations, which included manipulation with the patient under anesthesia (5 knees), wound revision (3 knees), and component revision (5 knees).
There were 6 intraoperative complications (10%).
A postoperative complication occurred in 16 knees (26%).

Conclusions

The vast majority of patients treated with total knee arthroplasty after a previous fracture of the tibial plateau have substantial improvement in function and relief of pain. However, these patients are at increased risk for perioperative complications, as evidenced by the high reoperation rate of 21% in this study.

Level of evidence: Therapeutic study Level IV (case series [no, or historical, control group]). Copyright remains with the authors and publisher.

Total Knee Arthroplasty in Patients with a Prior Fracture of the Tibial Plateau

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Total Knee Arthroplasty in Patients with a Prior Fracture of the Tibial Plateau

Weiss, Lewallen, et al.·J Bone Joint Surg Am·2003·169 citations·Case series

|

Background

A fracture of the tibial plateau may predispose the knee to the development of posttraumatic arthritis. Malunion, intra-articular chondro-osseous defects, limb malalignment, retained internal fixation devices, and poor surrounding soft tissues may in turn compromise the outcome of total knee arthroplasty. The aim of our study was to evaluate the results of total knee arthroplasty in patients with a previous fracture of the tibial plateau.

Methods

The results of 62 condylar total knee arthroplasties performed with cement, from 1988 to 1999, in 62 patients with a previous fracture of the tibial plateau were reviewed.
The fracture of the tibial plateau had been treated by open reduction and internal fixation in 38 knees, external fixation in one knee, and nonoperatively in 23 knees.
There were 40 women and 22 men with an average age of 63 years at the time of the arthroplasty.
Knee Society scores were recorded preoperatively and at the time of follow-up, at an average of 4.7 years, and complications were noted.
No patient was lost to follow-up.

Results

The mean Knee Society scores improved significantly (p < 0.0001), from 43.9 points for pain and 52 points for function preoperatively to 82.9 and 84 points, respectively, at the time of the latest follow-up.
There were 13 reoperations, which included manipulation with the patient under anesthesia (5 knees), wound revision (3 knees), and component revision (5 knees).
There were 6 intraoperative complications (10%).
A postoperative complication occurred in 16 knees (26%).

Conclusions

The vast majority of patients treated with total knee arthroplasty after a previous fracture of the tibial plateau have substantial improvement in function and relief of pain. However, these patients are at increased risk for perioperative complications, as evidenced by the high reoperation rate of 21% in this study.

Level of evidence: Therapeutic study Level IV (case series [no, or historical, control group]). Copyright remains with the authors and publisher.

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