Naylor Brandon, Butler Justin, Bradham Anita A, Gresham Natalie, Schwab Joseph M, Garrett Jeffrey
Total Joint Specialists Northside Hospital.
The Core Institute.
Orthop Rev (Pavia). 2025 Sep 4;17:143563. doi: 10.52965/001c.143563. eCollection 2025.
INTRODUCTION/BACKGROUND: Complex articular fractures around the knee in the elderly patient present an ongoing challenge regarding optimal treatment. While extensive research has evaluated immediate arthroplasty following fracture of the proximal femur, distal femur, proximal humerus, and elbow, relatively little focus has been given to immediate arthroplasty following complex tibia plateau fractures.
As seen with many other fractures, arthroplasty can shorten recovery and hospital stay and allow early weight-bearing with improved mobility while minimizing complications and possible future conversion arthroplasty cost. Notably, total knee arthroplasty (TKA) in the setting of post-traumatic arthritis has demonstrated worse outcomes when compared to TKA for osteoarthritis. Further, increased complication rates have been reported when TKA is performed following failed open reduction internal fixation compared to TKA for acute fracture.
Potential candidates for acute arthroplasty include the elderly patient with pre-existing degenerative joint disease, poor bone quality, complex articular fractures, inability to comply with weight-bearing restrictions, and cases where additional procedures may be poorly tolerated. When choosing arthroplasty, the principles of revision joint arthroplasty and implant selection remain critical. Meticulous preoperative planning, multidisciplinary perioperative management, and a well-executed technique are essential when performing arthroplasty for acute tibial plateau fractures in the elderly.
引言/背景：老年患者膝关节周围复杂关节骨折的最佳治疗仍是一项持续的挑战。虽然已有大量研究评估了股骨近端、股骨远端、肱骨近端和肘部骨折后的一期关节置换术，但对于复杂胫骨平台骨折后的一期关节置换术关注相对较少。
与许多其他骨折一样，关节置换术可缩短康复时间和住院时间，允许早期负重并改善活动能力，同时将并发症和未来可能的翻修关节置换术成本降至最低。值得注意的是，与骨关节炎的全膝关节置换术（TKA）相比，创伤后关节炎患者的TKA结果更差。此外，与急性骨折的TKA相比，切开复位内固定失败后进行TKA的并发症发生率更高。
急性关节置换术的潜在候选者包括患有既往退行性关节疾病、骨质不佳、复杂关节骨折、无法遵守负重限制的老年患者，以及可能难以耐受额外手术的病例。选择关节置换术时，翻修关节置换术的原则和植入物选择仍然至关重要。对于老年急性胫骨平台骨折患者进行关节置换术时，精心的术前规划、多学科围手术期管理和良好执行的技术至关重要。
