Total knee arthroplasty following surgical treatment of tibial plateau fractures - A retrospective cohort study.

BACKGROUND

Previous studies have shown the risk of post-traumatic osteoarthritis to be high following tibial plateau fracture surgery. Several investigations have examined the risk of total knee arthroplasty (TKA) following tibial plateau fracture treatment, but the risk of TKA in relation to the general population in Sweden has not previously been explored.

AIM

To determine the incidence of TKA following surgical treatment of tibial plateau fractures and compare it with that of an age-matched population in Sweden.

METHODS

A total of 349 tibial plateau fractures treated with open reduction internal fixation between 2002 and 2010 were identified from local hospital registers using diagnosis and surgical codes. The cohort was cross-matched with the Swedish Knee Arthroplasty Register to determine which patients had been treated with TKA within 10 years of fracture surgery. The incidence of primary TKA in the age-matched population in Sweden was obtained from the National Patient Register for comparison.

RESULTS

Mortality-adjusted prevalence of TKA at 10 years following fracture surgery was 6.7% (relative risk (RR) = 5.5) and peaked during the second postoperative year (RR=19.3). High age was independently associated with increased risk of TKA (P=0.004); no other examined patient factors were significantly associated with TKA.

CONCLUSION

The overall prevalence of TKA at 10 years following tibial plateau fracture surgery is low at 6.7%, however the risk is many times greater than that of the age-matched population in Sweden. The majority of patients require TKA within a few years of fracture treatment, hence post-traumatic osteoarthritis may arguably have not been the reason for TKA as this would have taken longer to develop.