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 Adult Knee Reconstruction Test 1: Revision Total Knee Arthroplasty
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The Journal of Bone and Joint Surgery (American) 85:218-221 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Total Knee Arthroplasty in Patients with a Prior Fracture of the Tibial Plateau

Nicholas G. Weiss, MD, Javad Parvizi, MD, FRCS, Robert T. Trousdale, MD, Rex D. Bryce, MD and David G. Lewallen, MD

Investigation performed at the Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

Nicholas G. Weiss, MD
Javad Parvizi, MD, FRCS
Robert T. Trousdale, MD
Rex D. Bryce, MD
David G. Lewallen, MD
Department of Orthopedics, Mayo Clinic and Mayo Foundation, 200 First Street S.W., Rochester, Minnesota 55905. E-mail address for R.T. Trousdale: trousdale.robert{at}mayo.edu

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: A fracture of the tibial plateau may predispose the knee to the development of posttraumatic arthritis. Malunion, intra-articular chondro-osseous defects, limb malalignment, retained internal fixation devices, and poor surrounding soft tissues may in turn compromise the outcome of total knee arthroplasty. The aim of our study was to evaluate the results of total knee arthroplasty in patients with a previous fracture of the tibial plateau.

Methods: The results of sixty-two condylar total knee arthroplasties performed with cement, from 1988 to 1999, in sixty-two patients with a previous fracture of the tibial plateau were reviewed. The fracture of the tibial plateau had been treated by open reduction and internal fixation in thirty-eight knees, external fixation in one knee, and nonoperatively in twenty-three knees. There were forty women and twenty-two men with an average age of sixty-three years at the time of the arthroplasty. Knee Society scores were recorded preoperatively and at the time of follow-up, at an average of 4.7 years, and complications were noted. No patient was lost to follow-up.

Results: The mean Knee Society scores improved significantly (p < 0.0001), from 43.9 points for pain and 52 points for function preoperatively to 82.9 and 84 points, respectively, at the time of the latest follow-up. There were thirteen reoperations, which included manipulation with the patient under anesthesia (five knees), wound revision (three knees), and component revision (five knees). There were six intraoperative complications (10%). A postoperative complication occurred in sixteen knees (26%).

Conclusions: The vast majority of patients treated with total knee arthroplasty after a previous fracture of the tibial plateau have substantial improvement in function and relief of pain. However, these patients are at increased risk for perioperative complications, as evidenced by the high reoperation rate of 21% in this study.

Level of Evidence: Therapeutic study Level IV (case series [no, or historical, control group]). See Instructons to Authors for a complete description of levels of evidence.



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