Highlights
- •In elderly patients, treatment of displaced proximal tibia fractures presents an high rate of failure because of poor bone quality.
- •Acute total knee arthroplasty for tibial plateau fractures in the elderly may overcome fracture healing problems and ensure a faster recovery.
- •Acute knee replacement is a demanding surgery, similarly to prosthetic revision, and should be reserved for selected patients and experienced surgeons.
- •Previous series showed encouraging results and reported complications are rare but higher than elective knee arthroplasty.
Abstract
Background
Displaced proximal tibia fractures in the elderly may be very difficult to manage.
If osteosynthesis represents the standard of care in the younger patients, in the
aged population this solution is controversial because a significant failure rate
has been reported after internal fixation. Moreover, osteoarthritis progression following
tibial plateau fractures is common, often requiring a subsequent total knee arthroplasty
(TKA). In recent years, in order to overcome the fracture healing problems and to
allow immediate full weight bearing, primary TKA after tibial plateau fractures in
elderly patients has gained popularity.
Material and methods
from 2015 to 2019, 11 tibial plateau fractures in elderly patients with pre-existing
osteoarthritis were treated with a primary TKA. Age, gender, mechanism of trauma,
pre-operative autonomy level, fractures classification, degree of osteoarthritis and
intraoperative data (ligamentous stability and type of implant) were collected. After
a mean follow-up of 28 months, Knee Society Score (KSS), post-operative autonomy level
and Forgotten Joint Score (FJS) were evaluated. The radiological assessment (signs
of loosening, limb axis and patellar height indices) and complications were also recorded.
Results
according to fracture type and ligamentous competence, 6 cases of posterior-stabilized
(PS) design and 5 cases of semi-constrained TKA were implanted. At the final follow
up, mean KSS knee score was 83±16 and mean KSS functional score was 74±15. Mean pre-operative
autonomy level assessed with the Parker scale, was significantly higher than the post-operative
one (7.5±1.4 vs 5.6 ± 1.3). Mean FJS was 66 ± 14. No lines of radiolucency or limb
malalignment were found at the final radiological follow-up. One major complication
was recorded: one acute periprosthetic infection. One patient reported a periprosthetic
femoral fracture after 26 months.
Conclusion
Based on our and results and those reported on literature, primary TKA is a suitable
option in case of tibial plateau fractures in elderly patients with pre-existing osteoarthritis
and poor bone quality, in which osteosynthesis outcome may be poor. Unlike ORIF, primary
TKA may allow immediate weightbearing and a faster recovery. Nevertheless, it is a
demanding surgery with a significant complications rate and should be reserved for
selected patients and experienced surgeons.
Keywords
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Article info
Publication history
Published online: February 06, 2021
Accepted:
February 2,
2021
Received in revised form:
November 16,
2020
Received:
September 2,
2020
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
