The Journal of Bone and Joint Surgery (American) 83:1144-1148 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
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 and
Thomas Sculco, MD
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{at}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.
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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