BACKGROUND

The purpose of this study was to quantify the incidence of total knee arthroplasty (TKA) and other osteoarthritis-related procedures following surgical and conservative treatment of tibial plateau fractures (TPF). Secondary goal was to analyse the long-term clinical outcomes and identify risk factors for secondary interventions and poor outcomes.

METHODS

All patients diagnosed with TPF at a single level 1 university trauma centre between January 1, 2008 and December 31, 2016 were retrospectively reviewed. Clinical outcomes were measured by use of the Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee Score (IKDC) and the Tegner Activity Score (TAS). Joint-preserving interventions and conversions to TKA were recorded as well as demographic data, injury mechanisms, treatment specifics and complications.

RESULTS

105 cases of TPF, 89 with surgical and 16 with conservative treatment, with a median follow-up of 10.4 years (interquartile range, IQR 9-13), were included. The conversion rate to TKA was 2%, with all cases occurring in the conservative treatment group. 9% underwent a joint-preserving intervention. Higher body mass index (BMI) was associated with an increased risk for secondary intervention (HR 1.4, p = 0.03). The overall KOOS was 78.7 (IQR 69-87) for surgical and 86 (IQR 70-93) for conservative treatment. The IKDC score was 63.6 ± 16.5 for surgical and 66.3 ± 22.2 for conservative treatment and the median TAS was 3 (IQR 3-4 vs. 3-6) for both groups. In the surgical treatment cohort, a negative correlation was found between Schatzker classification (Spearman´s r = -0.24, p = 0.03), duration of surgery (Spearman´s r = -0.23, p = 0.03), American Society of Anesthesiologists (ASA) risk classification (Spearman´s r = -0.28, p = 0.01) and the IKDC score. A higher TAS was observed for non-smokers (median 3, IQR 3-4) compared to smokers (median 2.5, IQR 2-3, p = 0.02).

CONCLUSIONS

There was a low incidence of TKA and joint-preserving, osteoarthritis-related procedures following TPF. Both conservative and surgical treatments can achieve satisfactory long-term clinical outcomes, when appropriately indicated. Obese patients are at increased risk for secondary interventions. The expectations of patients with a higher ASA risk score and complex fractures, accompanied by longer surgical times, should be managed carefully to ensure a realistic outlook on functional outcomes.