Long-Term Incidence of Total Knee Arthroplasty after Open Reduction and Internal Fixation of Proximal Tibial and Distal Femoral Fractures: A Nationwide Cohort Study

Kuang-Ting Yeh,Ru-Ping Lee,Wen-Tien Wu,Ing-Ho Chen,Jen-Hung Wang,Chen-Chie Wang

doi:10.3390/jcm10235685

Abstract

Knee fractures often require open reduction internal fixation (ORIF) for knee function recovery. More than one fifth of patients with knee fractures subsequently develop posttraumatic arthritis, and over 5% of them need total knee arthroplasty (TKA). We conducted this nationwide retrospective cohort study using the data of 2,000,000 people in the general population who received TKA and were followed up in the 17-year period 2001–2017, through random sampling of the Taiwan National Health Insurance Research Database. We matched the ORIF and non-fracture groups by a propensity score, based on age, sex, index date of surgery, and comorbidities enrolled in CCI calculated at a 1:1 ratio. The average proportion of subjects receiving TKA after ORIF for distal femoral or proximal tibial fractures was 2.0 per 1000 person-years, which was significantly higher than that in the non-fracture group. Patients aged 20–65 years and males represented a significantly higher proportion of subjects receiving TKA after ORIF than that in the non-fracture group. The proportion of subjects receiving TKA for the 20–65-year subgroup of the ORIF group was 4%, and that for the male subgroup was 1.5%; both rates increased over the 17-year follow-up period. More aggressive intraoperative and postoperative adjuvant therapies may be necessary for these subgroups.

Highlights

Fractures of the distal femur, proximal tibia, and patella often engender inferior knee function [1], poor health-related quality of life [2], and further development of posttraumatic knee arthritis [3]
A previous study reported that a major factor for poor functional status after trauma was posttraumatic osteoarthritis, the incidence of which was as high as 75% [14]
A 2014 Canadian nationwide matched population-based cohort study reported that the overall incidence of tibial plateau fractures leading to end-stage posttraumatic osteoarthritis that required further total knee arthroplasty (TKA) was 7.3% at 10 years after open reduction internal fixation (ORIF); relevant risk factors included increasing age, bicondylar fracture, concomitant meniscal tear injury, increased medical comorbidities, and the female sex [15]

Summary

Introduction

Fractures of the distal femur, proximal tibia, and patella often engender inferior knee function [1], poor health-related quality of life [2], and further development of posttraumatic knee arthritis [3]. Of cases following intra-articular fractures [4] This incidence does not appear to have decreased over time, despite advancements in fracture management and care strategies [5]. Posttraumatic knee arthritis is a critical risk factor for an increased rate of total knee arthroplasty (TKA), in addition to a relatively long human lifespan and an increased rate of obesity [6]. A study revealed that the rates of in-hospital adverse events after TKA decreased gradually from 2010 to 2017; critical risk factors for severe adverse events included the male sex [9]. Age and sex differences, which are significantly correlated with future knee function and quality of life, appear to be critical factors for TKA-related knee function. The use of conventional clinical approaches to investigate the relationship between open reduction internal fixation (ORIF)

Methods

Discussion

Conclusion