Background: 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. The goal of this study was to evaluate the results of such
procedures after a minimum of five years of follow-up.
Methods: We retrospectively analyzed the outcomes
of fifteen total knee arthroplasties performed at an average of
38.6 months (range, eight months to eleven years) after open reduction
and internal fixation of a fracture of the 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 points (range, 44 to 91 points) postoperatively. Four
knees were scored as excellent, 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 health, 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 active postoperative
arc of motion was 105° (range, 70° to 135°) compared with 87° (range,
20° to 125°) preoperatively. 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 manipulation). 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 arthroplasty after open reduction and internal fixation
of a fracture of the tibial plateau decreases pain and improves
knee function, but the procedure is technically demanding and is associated
with a high failure rate (five of fifteen).