Conversion of Tibial Plateau Fractures to Total Knee Arthroplasty is Associated with Worse Patient-Reported Outcomes, Increased Operative Time and Increased Complications.

ABSTRACT

BACKGROUND: 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. METHODS: 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 14 ratio by sex, body mass index, and American Society of Anesthesiologists class to 208 patients undergoing primary TKA. A second 11 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 2-years postoperatively. Independent t-tests and Chi-square tests were used for statistical comparisons. RESULTS: The TPF patients were significantly younger than both the 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 KOOS JR scores at 2-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). No significant differences in these metrics were seen between the TPF group and the revision group. Additionally, TPF patients were more likely to require a manipulation under anesthesia (MUA) than both primary and revision patients (21.2 versus 5.8 versus 5.8%, P = 0.001). CONCLUSION: 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 MUA was higher than in both matched groups. These findings provide valuable information that can affect preoperative patient education and postoperative management regimens for these patients. They also emphasize the need for a conversion to TKA code due to the increased complexity and complications seen in this more difficult subset of TKAs.