Total Knee Arthroplasty After Surgery for Tibial Plateau Fractures
Ten years after tibial plateau fracture surgery, approximately 7.3% of patients had a total knee arthroplasty. This is an approximately 5.3 times greater likelihood compared with the matched group from the general population. Elderly patients, patients with mal aligned or bicondylar fractures, those with associated meniscal tears, and patients with significant comorbidities, are all patients who are more likely to require total knee arthroplasty after repair of their respective tibial plateau fractures. Displaced intra-articular tibial plateau fractures were considered a risk factor for the development of arthritis and are usually treated by ORIF. In spite of this, the rate of total knee arthroplasty is still low after ORIF of tibial plateau fractures (7.3% at 10 years after fixation). This low rate of future total knee arthroplasty explains why we shouldn’t use surgical approaches that may be needed for future total knee arthroplasties (such as a single midline incision) as an alternative to approaches which are ideal for ORIF of the present fracture. Because only 7.3% of these patients will a total knee arthroplasty in the subsequent decade, the location of the incision for an ORIF should not be based off of what may theoretically be helpful in a future surgery which is unlikely to occur. The incisional location(s) should be based off what is ideal for fixation of the fracture now. The incisions can be medial, lateral, posteromedial, or a combination. Two separate incisions for these fractures are better than a single long midline incision that may lead to soft tissue complications.
