Knee joint replacement as primary treatment for proximal tibial fractures: analysis of clinical results of twenty-two patients with mean follow-up of nineteen months.

Abstract

Proximal tibial fractures are typically treated with osteosynthesis. In older patients, this method has been reported to be associated with a high complication rate, risk of post-traumatic osteoarthritis, and long partial or non-weight bearing during the recovery phase. To avoid these problems, primary total knee replacement (TKR) has become an increasingly common treatment option. Twenty-two patients (mean age 74years, SD 12) underwent primary TKR due to tibial plateau fracture. Follow-up data were available for a mean of 19 (SD 16) months. Trauma mechanism, fracture classification, type of prosthesis used, complications, and re-operations during the follow-up were recorded. The Knee Society Score (KSS), Oxford Knee Score (OKS), range of flexion, and patient satisfaction were evaluated. 13/22 of the fractures were due to a low-energy trauma. At final follow-up, mean KSS was 160 (SD 39) and mean OKS 27 (SD 11) points. Mean flexion was 109° (SD 16°). 14/17 of the patients were satisfied or highly satisfied with their post-operative knee and 11/17 reported their knee to be same or better than pre-trauma. 2/22 of the patients had complications requiring revision surgery. TKR as a primary definitive method seems to be a useful alternative to osteosynthesis, enabling immediate full weight bearing and rapid mobilization of patients. The risk of complications associated with primary TKR is higher than those reported after TKR due to primary osteoarthritis but lower than those reported after TKR due to secondary osteoarthritis.