Risk of conversion to total knee arthroplasty after surgically treated tibial plateau fractures: an observational cohort study of 439 patients
DOI:
https://doi.org/10.2340/17453674.2024.40605Keywords:
Arthroplasty, Fractures, KneeAbstract
Background and purpose: We aimed to assess joint failure rate, i.e., subsequent conversion to TKA after surgical treatment of a tibial plateau fracture (TPF). Secondary aims were to explore the association between joint failure and fracture type, and to determine the risk of failure associated with inadequate joint surface reduction.
Methods: We included all patients ≥ 18 years of age with a surgically treated TPF, treated at Uppsala University Hospital between 2002 and 2015. All fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Traumatology Association (AO/OTA) classification. Postoperative radiographs were evaluated to determine the quality of joint surface inadequate reduction, defined as an articular step-off ≥ 2 mm. The study cohort was linked with the Swedish Arthroplasty Register (SAR) for information on subsequent total knee arthroplasty (TKA).
Results: 439 patients (57% women) with a mean age of 55 years (SD 17) were included. According to the AO/OTA classification, the fracture distribution was B1: 4.8%, B2: 10%, B3: 47%, C1: 12%, C2: 6.4%, and C3: 19%. 23 patients (5.2%) were converted to a TKA within 2 years of initial surgery, and 34 patients (7.7%) had been converted by the end of follow-up (16 years). AO/OTA type B3 and C3 had a 6.8 (95% confidence interval [CI] 1.6–29) times greater risk of joint failure compared with B1–2 and C1–C2 at 2 years’ follow-up. Inadequate joint surface reduction led to an 8.4 (CI 3.6–20) times greater risk of conversion to TKA at 2 years’ follow-up.
Conclusion: Overall, 5.2% were converted to a TKA within 2 years. Fracture types AO/OTA B3 and C3 with a comminuted articular surface and inadequate joint surface reduction were strongly associated with joint failure.
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Court-Brown C M, Caesar B. Epidemiology of adult fractures: a review. Injury 2006; 37(8): 691-7. doi: 10.1016/j.injury.2006.04.130. DOI: https://doi.org/10.1016/j.injury.2006.04.130
Donovan R L, Smith J R A, Yeomans D, Bennett F, White P, Chesser T J S. Epidemiology and outcomes of tibial plateau fractures in adults aged 60 and over treated in the United Kingdom. Injury 2022; 53(6): 2219-25. doi: 10.1016/j.injury.2022.03.048. DOI: https://doi.org/10.1016/j.injury.2022.03.048
Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J 2016; 98B(3): 291-7. doi: 10.1302/0301-620X.98B3.36515. DOI: https://doi.org/10.1302/0301-620X.98B3.36515
Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Hemiarthroplasty versus nonoperative treatment of displaced 4-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg 2011; 20(7): 1025-33. doi: 10.1016/j.jse.2011.04.016. DOI: https://doi.org/10.1016/j.jse.2011.04.016
McKee M D, Veillette C J H, Hall J A, Schemitsch E H, Wild L M, McCormack R, et al. A multicenter, prospective, randomized, controlled trial of open reduction-internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients. J Shoulder Elbow Surg 2009; 18(1): 3-12. doi: 10.1016/j.jse.2008.06.005. DOI: https://doi.org/10.1016/j.jse.2008.06.005
Scott C E H, Davidson E, Macdonald D J, White T O, Keating J F. Total knee arthroplasty following tibial plateau fracture: a matched cohort study. Bone Joint J 2015; 97-B(4): 532-8. doi: 10.1302/0301-620X.97B4.34789. DOI: https://doi.org/10.1302/0301-620X.97B4.34789
Annette W-Dahl A, Kärrholm J, Rogmark C, Nauclér E, Nåtman J, Bülow E, et al. Svenska Ledprotesregistret. Årsrapport 2021 2021. Available from: https://slr.registercentrum.se/om-registret/arsrapporter/p/r1VTtHNvu.
Meinberg E G, Agel J, Roberts C S, Karam M D, Kellam J F. Fracture and dislocation classification compendium—2018. J Orthop Trauma 2018; 32(1): S1-170. doi: 10.1097/BOT.0000000000001063. DOI: https://doi.org/10.1097/BOT.0000000000001063
Schatzker J. Compression in the surgical treatment of fractures of the tibia. Clin Orthop Relat Res 1974; (105): 220-39. PMID: 4609653. DOI: https://doi.org/10.1097/00003086-197411000-00015
Landis J R, Koch G G. The measurement of observer agreement for categorical data. Biometrics 1977; 33(1): 159. doi: 10.2307/2529310. DOI: https://doi.org/10.2307/2529310
Elsoe R, Johansen M B, Larsen P. Tibial plateau fractures are associated with a long-lasting increased risk of total knee arthroplasty: a matched cohort study of 7,950 tibial plateau fractures. Osteoarthritis Cartilage 2019; 27(5): 805-9. doi: 10.1016/j.joca.2018.12.020. DOI: https://doi.org/10.1016/j.joca.2018.12.020
Wasserstein D, Henry P, Paterson J M, Kreder H J, Jenkinson R. Risk of total knee arthroplasty after operatively treated tibial plateau fracture. J Bone Joint Surg 2014; 96(2): 144-50. doi: 10.2106/jbjs.l.01691. DOI: https://doi.org/10.2106/JBJS.L.01691
Manidakis N, Dosani A, Dimitriou R, Stengel D, Matthews S, Giannoudis P. Tibial plateau fractures: functional outcome and incidence of osteoarthritis in 125 cases. Int Orthop 2010; 34(4): 565-70. doi: 10.1007/s00264-009-0790-5. DOI: https://doi.org/10.1007/s00264-009-0790-5
Honkonen S E. Degenerative arthritis after tibial plateau fractures. J Orthop Trauma 1995; 9(4): 273-7. doi: 10.1097/00005131-199509040-00001. DOI: https://doi.org/10.1097/00005131-199509040-00001
Rasmussen P S. Tibial condylar fractures: impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am 1973; 55(7): 1331-50. PMID: 4586086. DOI: https://doi.org/10.2106/00004623-197355070-00001
DeCoster T A, Nepola J V, El-Khoury G Y. Cast brace treatment of proximal tibia fractures: a ten-year follow-up study. Clin Orthop Relat Res 1988; (231): 196-204. PMID: 3370874. DOI: https://doi.org/10.1097/00003086-198806000-00026
Rademakers M V, Kerkhoffs G M M J, Sierevelt I N, Raaymakers E L F B, Marti R K. Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results. J Orthop Trauma 2007; 21(1): 5-10. doi: 10.1097/BOT.0b013e31802c5b51. DOI: https://doi.org/10.1097/BOT.0b013e31802c5b51
Jagdev S S, Pathak S, Kanani H, Salunke A. Functional outcome and incidence of osteoarthritis in operated tibial plateau fractures. Arch Bone Joint Surg 2018; 6(6): 508-16. doi: 10.22038/abjs.2017.21582.1555.
Gaudinez R F, Mallik A R, Szporn M. Hybrid external fixation of comminuted tibial plateau fractures. Clin Orthop Relat Res 1996; (328): 203-10. doi: 10.1097/00003086-199607000-00032. DOI: https://doi.org/10.1097/00003086-199607000-00032
Tapper V S, Pamilo K J, Haapakoski J J, Toom A, Paloneva J. Risk of total knee replacement after proximal tibia fracture: a register-based study of 7,701 patients. Acta Orthop 2022; 93: 179-84. doi: 10.2340/17453674.2021.1006. DOI: https://doi.org/10.2340/17453674.2021.1006
Vaartjes T P, Assink N, Nijveldt R J, van Helden S H, Bosma E, El Moumni M, et al. Functional outcome after nonoperative management of tibial plateau fractures in skeletally mature patients: what sizes of gaps and stepoffs can be accepted? Clin Orthop Relat Res 2022; 480(12): 2288-95. doi: 10.1097/CORR.0000000000002266. DOI: https://doi.org/10.1097/CORR.0000000000002266
Parkkinen M, Lindahl J, Mäkinen T J, Koskinen S K, Mustonen A, Madanat R. Predictors of osteoarthritis following operative treatment of medial tibial plateau fractures. Injury [Internet] 2018; 49(2): 370-5. doi: 10.1016/j.injury.2017.11.014. DOI: https://doi.org/10.1016/j.injury.2017.11.014
Singleton N, Sahakian V, Muir D. Outcome after tibial plateau fracture: how important is restoration of articular congruity? J Orthop Trauma 2017; 31(3): 158-63. doi: 10.1097/BOT.0000000000000762. DOI: https://doi.org/10.1097/BOT.0000000000000762
Barei D P, Nork S E, Mills W J, Coles C P, Henley M B, Benirschke S K. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg 2006; 88(8): 1713-21. doi: 10.2106/JBJS.E.00907. DOI: https://doi.org/10.2106/JBJS.E.00907
Luo C F, Sun H, Zhang B, Zeng B F. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 2010; 24(11): 683-92. doi: 10.1097/BOT.0b013e3181d436f3. DOI: https://doi.org/10.1097/BOT.0b013e3181d436f3
Parratte S, Ollivier M, Argenson J N. Primary total knee arthroplasty for acute fracture around the knee. Orthop Traumatol Surg Res 2018; 104(1): S71-80. doi: 10.1016/j.otsr.2017.05.029. DOI: https://doi.org/10.1016/j.otsr.2017.05.029
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