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Total Knee Arthroplasty After Open Reduction and Internal Fixation of Fractures of the Tibial Plateau A Minimum Five-Year Follow-up Study
Khaled J. Saleh, MD, MSc, FRCS(C); Pamela Sherman, MD; Pam Katkin, PA; Russell Windsor, MD; Stephen Haas, MD; Richard Laskin, MD; Thomas Sculco, MD
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Investigation performed at the Hospital for Special Surgery, Cornell Medical Center, New York, NY, and the University of Minnesota, Minneapolis, Minnesota
Khaled J. Saleh, MD, MSc, FRCS(C)
Department of Orthopaedic Surgery and Clinical Outcome Research Center, University of Minnesota, 420 Delaware Street S.E., Box 492, Minneapolis, MN 55455. E-mail address: saleh002@tc.umn.edu

Pamela Sherman, MD
Pam Katkin, PA
Russell Windsor, MD
Stephen Haas, MD
Richard Laskin, MD
Thomas Sculco, MD
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study. K.J. Saleh is supported by a career grant from the Orthopaedic Research and Education Foundation.

A video supplement to this article is available from the Video Journal of Orthopaedics. A video clip is available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

J Bone Joint Surg Am, 2001 Aug 01;83(8):1144-1148
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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).

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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