Clapp Ian M, Orton Cody J, Kapron Claire R, Blackburn Brenna E, Gililland Jeremy M, Anderson Lucas A, Pelt Christopher E, Peters Christopher L, Archibeck Michael J
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah.
J Arthroplasty. 2025 Mar;40(3):619-624. doi: 10.1016/j.arth.2024.08.050. Epub 2024 Sep 2.
Prior open reduction and internal fixation (ORIF) of tibial plateau fracture (TPF) adds complexity to subsequent total knee arthroplasty (TKA). The purpose of this study was to compare the outcomes of patients undergoing a TKA following prior ORIF of TPF to patients undergoing a primary TKA for osteoarthritis and an aseptic revision TKA.
There were 52 patients who underwent primary TKA following prior ORIF of TPF between January 2009 and June 2021, who were included and matched in a 1:4 ratio to 208 patients undergoing primary TKA. A second 1:1 matched comparison to 52 aseptic revision TKA patients was also included. The Knee injury and Osteoarthritis Outcome Score for Joint Replacement scores were obtained preoperatively and at two years postoperatively. Independent t-tests and Chi-square tests were used for statistical comparisons.
The TPF patients were significantly younger than both primary and revision cohorts (55 ± 14.0 versus 63 ± 16.3 versus 64 ± 9.5, P < 0.001). Compared to primary TKA patients, the TPF group had worse Knee injury and Osteoarthritis Outcome Score for Joint Replacement scores at two years (46.9 ± 18.5 versus 66.2 ± 17.8, P = 0.0152), higher rates of wound complications (15.4 versus 3.9%, P = 0.0020), and increased operative times (140.2 ± 45.3 versus 95.2 ± 25.7, P < 0.0001). Additionally, TPF patients were more likely to require a manipulation under anesthesia than both primary and revision patients (21.2 versus 5.8 versus 5.8%, P = 0.001).
The TKAs following ORIF of TPF are more like revision TKAs than primary TKAs in terms of patient-reported outcomes, operative times, and wound complications. The rate of manipulation under anesthesia was higher than in both matched groups. These findings provide valuable information that can affect preoperative patient education and postoperative management regimens. They also emphasize the need for a conversion TKA code due to increased complexity and complications seen in this more difficult subset of TKAs.
胫骨平台骨折（TPF）既往切开复位内固定（ORIF）会增加后续全膝关节置换术（TKA）的复杂性。本研究的目的是比较TPF既往ORIF后行TKA的患者与因骨关节炎行初次TKA及无菌性翻修TKA患者的结局。
2009年1月至2021年6月期间，52例TPF既往ORIF后行初次TKA的患者被纳入研究，并按1:4的比例与208例行初次TKA的患者进行匹配。还纳入了与52例无菌性翻修TKA患者进行1:1匹配的比较。术前及术后两年获取关节置换的膝关节损伤和骨关节炎结局评分（Knee injury and Osteoarthritis Outcome Score for Joint Replacement）。采用独立t检验和卡方检验进行统计学比较。
TPF患者明显比初次手术组和翻修手术组患者年轻（55±14.0岁 vs 63±16.3岁 vs 64±9.5岁，P<0.001）。与初次TKA患者相比，TPF组术后两年的膝关节损伤和骨关节炎结局评分更低（46.9±18.5 vs 66.2±17.8，P = 0.0152），伤口并发症发生率更高（15.4% vs 3.9%，P = 0.0020），手术时间更长（140.2±45.3分钟 vs 95.2±25.7分钟，P<0.0001）。此外，TPF患者比初次手术组和翻修手术组患者更有可能需要在麻醉下进行手法操作（21.2% vs 5.8% vs 5.8%，P = 0.001）。
就患者报告的结局、手术时间和伤口并发症而言，TPF的ORIF后的TKA更类似于翻修TKA而非初次TKA。麻醉下手法操作的发生率高于两个匹配组。这些发现提供了可影响术前患者教育和术后管理方案的有价值信息。它们还强调了由于在这种更具挑战性的TKA亚组中观察到的复杂性和并发症增加，需要一个转换TKA编码。
