Soft-tissue injury in total knee arthroplasty.

Abstract

To The Editor: I read with interest the paper entitled Total Knee Arthroplasty After Open Reduction and Internal Fixation of Fractures of the Tibial Plateau. A Minimum Five-Year Follow-up Study (2001;83:1144-8), by Saleh et al. I agree that there is little information in the literature regarding the outcome of total knee arthroplasty following open reduction and internal fixation of fractures of the tibial plateau. I also agree that the procedure is demanding and associated with a high failure rate. I would like to ask the authors whether they think that early extensive dissection of soft tissue and an excessive use of implants have increased the rate of complications following total knee replacement. Do they think that there is a role for early primary total knee replacement, perhaps when the insult to the soft tissue has settled? Also, do the authors think that hybrid external fixation is a better method of fixation for severe injury to the tibial plateau? Because this type of fixation is applied percutaneously, it would not result in the extensive soft-tissue dissection that would otherwise be required for exposure of the area and placement of one or two plates for fixation. The paper does not clearly describe the extent of the soft-tissue injury sustained in association with the tibial plateau injury. A ruptured medial collateral ligament, in particular, would result in instability of the knee following knee arthroplasty. I would be grateful for your comments. -Adnan A. Faraj, FRCS(Orth) 28 Colston Close, Crow Tree Lane, Bradford BD8 0BN, United Kingdom, E-mail address: adnanfaraj@hotmail.com K. Saleh, D. Sanders, P. Cole, R. Laskin, T. Sculco, R. Windsor, and S. …