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Total Knee Arthroplasty After Open Reduction and Internal Fixation of Fractures of the Tibial Plateau : A Minimum Five-Year Follow-up Study

Saleh, Khaled J. MD, MSc, FRCS(C); Sherman, Pamela MD; Katkin, Pam PA; Windsor, Russell MD; Haas, Stephen MD; Laskin, Richard MD; Sculco, Thomas MD

Journal of Bone & Joint Surgery - American Volume: August 2001 - Volume 83 - Issue 8 - p 1144–1148
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Background: There is little information in the literature regarding the outcome of total knee arthroplasty following open reduction and internal fixation of fractures of the tibial plateau. The goal of this study was to evaluate the results of such procedures after a minimum of five years of follow-up.

Methods: We retrospectively analyzed the outcomes of fifteen total knee arthroplasties performed at an average of 38.6 months (range, eight months to eleven years) after open reduction and internal fixation of a fracture of the tibial plateau in fifteen consecutive patients. The average duration of follow‐up after the total knee arthroplasty procedures was 6.2 years (range, 5.4 to 11.1 years). The average age of the patients was fifty‐six years (range, thirty‐seven to sixty‐eight years) at the time of the arthroplasty. We evaluated the outcomes on the basis of the Hospital for Special Surgery knee score, the Short Form-36 score, and radiographs of the knees.

Results: The average Hospital for Special Surgery knee score was 51 points (range, 20 to 74 points) before the arthroplasty, and it increased to 80 points (range, 44 to 91 points) postoperatively. Four knees were scored as excellent, eight had a good result, one was rated as fair, and two had a poor result. The average Short Form-36 scores were 58.0 points for general health, 72.4 points for bodily pain, 72.1 points for mental health, 58.3 points for physical functioning, 84.6 points for physical role functioning, 81.0 points for social functioning, and 57.7 points for vitality. The average active postoperative arc of motion was 105° (range, 70° to 135°) compared with 87° (range, 20° to 125°) preoperatively. Incomplete radiolucencies were noted on all of the postoperative radiographs made after the total knee arthroplasties. There was a high rate of infection (three patients), patellar tendon disruption (two patients), and postoperative secondary procedures (three patients required closed manipulation). The patients with infection were considered to have a failure of treatment: two required arthrodesis, and one required a two-stage exchange.

Conclusion: On the basis of our results, we concluded that total knee arthroplasty after open reduction and internal fixation of a fracture of the tibial plateau decreases pain and improves knee function, but the procedure is technically demanding and is associated with a high failure rate (five of fifteen).

Khaled J. Saleh, MD, MSc, FRCS(C); Department of Orthopaedic Surgery and Clinical Outcome Research Center, University of Minnesota, 420 Delaware Street S.E., Box 492, Minneapolis, MN 55455. E-mail address: saleh002@tc.umn.edu

Pamela Sherman, MD; Pam Katkin, PA; Russell Windsor, MD; Stephen Haas, MD; Richard Laskin, MD; Thomas Sculco, MD; Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

Copyright 2001 by The Journal of Bone and Joint Surgery, Incorporated
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