Abstract
BackgroundSurgical fixation of tibial plateau fracture in elderly patients with open reduction and internal fixation (ORIF) provides inferior outcomes compared with younger patients. Primary total knee arthroplasty (TKA) may be of benefit in elderly patients with a combination of osteoporotic bone and metaphyseal comminution. However, there continues to be conflicting evidence on the use of TKA for primary treatment of tibial plateau fracture. This systematic review was performed to quantify the outcomes and perioperative complication rates of TKA for primary treatment of tibial plateau fracture.Materials and methodsA comprehensive search of MEDLINE, Embase, and PubMed databases from inception through March 2018 was performed in accordance with PRISMA guidelines. Two reviewers independently screened papers for inclusion and identified studies featuring perioperative complications and outcomes of primary TKA for tibial plateau fracture. Weighted means and standard deviations are presented for each outcome.ResultsSeven articles (105 patients) were eligible for inclusion. All-cause mortality was 4.75 ± 4.85%. The total complication rate was 15.2 ± 17.3%. Regarding outcomes, Knee Society scores were most commonly reported. The average Knee Society Knee Score was 85.6 ± 5.5, while the average Knee Society Function Score was 64.6 ± 13.7. Average range of motion at final follow-up was 107.5 ± 10.0°.ConclusionsPrimary TKA for select tibial plateau fractures has acceptable clinical outcomes but does not appear to be superior to ORIF. It may be appropriate to treat certain geriatric patients with TKA to allow for early mobilization and reduce the need for reoperation. Other factors may need to be considered in deciding the optimal treatment.Level of evidenceLevel III.
Highlights
Fracture of the tibial plateau represents approximately 8% of fractures in elderly patients [1]
It may be appropriate to treat certain geriatric patients with total knee arthroplasty (TKA) to allow for early mobilization and reduce the need for reoperation
Primary TKA may be a viable treatment option for comminuted intraarticular tibial plateau fracture in older patients, there continues to be controversy surrounding the use of TKA for primary treatment of tibial plateau fracture
Summary
Fracture of the tibial plateau represents approximately 8% of fractures in elderly patients [1]. Interest has developed in treating tibial plateau fracture in elderly patients with primary total knee arthroplasty (TKA). This approach offers the advantage of early full weight bearing and avoids some of the potential complications seen following ORIF. Additional benefits to treating select patients with TKA compared with ORIF are the reduced rates of lower-extremity thrombosis, postoperative pneumonia, and postoperative deconditioning [7, 8]. This is largely due to the immediate stability of the knee and early mobilization made possible following TKA. This systematic review was performed to quantify the outcomes and perioperative complication rates of TKA for primary treatment of tibial plateau fracture
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