Total knee arthroplasty after open reduction and internal fixation of fractures of the tibial plateau - A minimum five-year follow-up study

Background: There is little information in the literature regarding the out come of total knee arthroplasty following open reduction and internal fixat ion of fractures of the tibial plateau. The goal of this study was to evalu ate the results of such procedures after a minimum of five years of follow- up. Methods: We retrospectively analyzed the outcomes of fifteen total knee art hroplasties performed at an average of 38.6 months (range, eight months to eleven years) after open reduction and internal fixation of a fracture of t he tibial plateau in fifteen consecutive patients. The average duration of follow-up after the total knee arthroplasty procedures was 6.2 years (range , 5.4 to 11.1 years). The average age of the patients was fifty-six years ( range, thirty-seven to sixty-eight years) at the time of the arthroplasty. We evaluated the outcomes on the basis of the Hospital for Special Surgery knee score, the Short Form-36 score, and radiographs of the knees. Results: The average Hospital for Special Surgery knee score was 51 points (range, 20 to 74 points) before the arthroplasty, and it increased to 80 po ints (range, 44 to 91 points) postoperatively. Four knees were scored as ex cellent, eight had a good result, one was rated as fair, and two had a poor result. The average Short Form-36 scores were 58.0 points for general heal th, 72.4 points for bodily pain, 72.1 points for mental health, 58.3 points for physical functioning, 84.6 points for physical role functioning, 81.0 points for social functioning, and 57.7 points for vitality. The average ac tive postoperative arc of motion was 105 degrees (range, 70 degrees to 135 degrees) compared with 87 degrees (range, 20 degrees to 125 degrees) preope ratively. Incomplete radiolucencies were noted on all of the postoperative radiographs made after the total knee arthroplasties. There was a high rate of infection (three patients), patellar tendon disruption (two patients), and postoperative secondary procedures (three patients required closed mani pulation). The patients with infection were considered to have a failure of treatment: two required arthrodesis, and one required a two-stage exchange . Conclusion: On the basis of our results, we concluded that total knee arthr oplasty after open reduction and internal fixation of a fracture of the tib ial plateau decreases pain and improves knee function, but the procedure is technically demanding and is associated with a high failure rate (five of fifteen).