Centre for Orthopaedic Research Alkmaar (CORAL), Alkmaar, the Netherlands; Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam UMC, Amsterdam, the Netherlands.
Centre for Orthopaedic Research Alkmaar (CORAL), Alkmaar, the Netherlands; Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, the Netherlands.
Knee. 2024 Oct;50:33-40. doi: 10.1016/j.knee.2024.07.018. Epub 2024 Aug 6.
Patients who sustain a tibial plateau fracture (TPF) have a higher risk of receiving total knee arthroplasty (TKA). Rarely, TKA is used as acute treatment for TPFs. This study aimed to compare both acute and delayed TKA following TPF with matched patients undergoing elective TKA for osteoarthritis.
A retrospective study was conducted including patients with either acute TKA as the primary treatment for TPF, or unplanned delayed TKA due to posttraumatic osteoarthritis. Both groups were matched to controls undergoing TKA for osteoarthritis. Questionnaires were completed cross-sectionally. Knee injury and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS), Oxford Knee Score (OKS), EQ-5D-5L, and complications were compared.
Thirty-four TPF patients (12 acute TKA, 22 delayed TKA) were matched 1:1. Mean age was 67.2 ± 9.9 years, 82% was female, and mean follow-up was 5.0 ± 2.9 years. No differences were found for the acute group compared to their controls (median KOOS-PS 73.1 vs. 69.3, p = 0.977; median OKS 43 vs. 45, p = 0.246; median EQ-5D-5L 0.87 vs. 1.00, p = 0.078). In the delayed group, scores were inferior compared to their controls (median KOOS-PS 63.9 vs 78.0, p = 0.003; median OKS 39 vs 44, p = 0.001; median EQ-5D-5L 0.81 vs 0.87, p = 0.008). Complications showed no significant differences.
Acute TKA for TPF shows no difference to a matched group of elective TKA, but delayed TKA following TPF yields worse results at mean 5-year follow-up. This suggests that TPFs in patients with a high risk of ultimately requiring TKA may benefit from primary treatment with TKA.
胫骨平台骨折（TPF）患者接受全膝关节置换术（TKA）的风险更高。很少有 TKA 被用作 TPF 的急性治疗。本研究旨在比较 TPF 后行急性和延迟 TKA 与因创伤后骨关节炎而行择期 TKA 的匹配患者。
本研究回顾性纳入了 TPF 患者，其中部分患者接受了急性 TKA 作为 TPF 的主要治疗，部分患者因创伤后骨关节炎而接受了计划外延迟 TKA。两组患者均与因骨关节炎行 TKA 的对照组相匹配。通过问卷调查进行横断面研究。比较了膝关节损伤和骨关节炎结果评分-物理功能简表（KOOS-PS）、牛津膝关节评分（OKS）、EQ-5D-5L 和并发症。
34 例 TPF 患者（12 例急性 TKA，22 例延迟 TKA）按 1:1 比例配对。平均年龄为 67.2±9.9 岁，82%为女性，平均随访时间为 5.0±2.9 年。与对照组相比，急性 TKA 组患者无明显差异（KOOS-PS 中位数为 73.1 分，69.3 分，p=0.977；OKS 中位数为 43 分，45 分，p=0.246；EQ-5D-5L 中位数为 0.87 分，1.00 分，p=0.078）。在延迟 TKA 组，与对照组相比，评分较低（KOOS-PS 中位数为 63.9 分，78.0 分，p=0.003；OKS 中位数为 39 分，44 分，p=0.001；EQ-5D-5L 中位数为 0.81 分，0.87 分，p=0.008）。并发症无显著差异。
TPF 行急性 TKA 与择期 TKA 匹配患者无差异，但 TPF 后行延迟 TKA 在平均 5 年随访时结果较差。这表明，对于最终需要 TKA 的高危 TPF 患者，TPF 可能受益于 TKA 作为主要治疗手段。
