Mid-term outcomes of acute and delayed total knee arthroplasty following tibial plateau fractures: A matched cohort study

Introduction: Patients who sustain a tibial plateau fracture (TPF) have a higher risk of receiving total knee arthroplasty (TKA). Rarely, TKA is used as acute treatment for TPFs. This study aimed to compare both acute and delayed TKA following TPF with matched patients undergoing elective TKA for osteoarthritis.

Materials and methods: A retrospective study was conducted including patients with either acute TKA as the primary treatment for TPF, or unplanned delayed TKA due to posttraumatic osteoarthritis. Both groups were matched to controls undergoing TKA for osteoarthritis. Questionnaires were completed cross-sectionally. Knee injury and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS), Oxford Knee Score (OKS), EQ-5D-5L, and complications were compared.

Results: Thirty-four TPF patients (12 acute TKA, 22 delayed TKA) were matched 1:1. Mean age was 67.2 ± 9.9 years, 82% was female, and mean follow-up was 5.0 ± 2.9 years. No differences were found for the acute group compared to their controls (median KOOS-PS 73.1 vs. 69.3, p = 0.977; median OKS 43 vs. 45, p = 0.246; median EQ-5D-5L 0.87 vs. 1.00, p = 0.078). In the delayed group, scores were inferior compared to their controls (median KOOS-PS 63.9 vs 78.0, p = 0.003; median OKS 39 vs 44, p = 0.001; median EQ-5D-5L 0.81 vs 0.87, p = 0.008). Complications showed no significant differences.

Conclusion: Acute TKA for TPF shows no difference to a matched group of elective TKA, but delayed TKA following TPF yields worse results at mean 5-year follow-up. This suggests that TPFs in patients with a high risk of ultimately requiring TKA may benefit from primary treatment with TKA.