Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2017; 8(2): 107-114
Published online Feb 18, 2017. doi: 10.5312/wjo.v8.i2.107
Total knee arthroplasty and fractures of the tibial plateau
Kenneth A Softness, Ryan S Murray, Brian G Evans
Kenneth A Softness, Ryan S Murray, Brian G Evans, Department of Orthopaedic Surgery, Georgetown University Medical Center, Georgetown University School of Medicine, Washington, DC 20007, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Kenneth A Softness, MS, Department of Orthopaedic Surgery, Georgetown University Medical Center, Georgetown University School of Medicine, 3800 Reservoir Road Northwest, Washington, DC 20007, United States.
Telephone: +1-305-4671119
Received: September 9, 2016
Peer-review started: September 10, 2016
First decision: October 20, 2016
Revised: November 30, 2016
Accepted: January 2, 2017
Article in press: January 4, 2017
Published online: February 18, 2017

Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation (ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty (TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed.

Keywords: Arthroplasty, Knee, Tibia, Intra-articular fractures, Fracture fixation

Core tip: It is well known that patients undergoing open reduction and internal fixation (ORIF) following tibial plateau fracture have a high rate of post-traumatic arthritis (PTOA) requiring total knee arthroplasty (TKA) in the future. Currently, ORIF is the standard of care for all patients requiring operative management. Small groups of select patients have shown good results with TKA as primary treatment of tibial plateau fracture. This group includes elderly patients with poor bone stock who are shown to have high rates of post-traumatic arthritis and fixation failure. In younger and more active patients, the options for salvage TKA in the case of PTOA is discussed, as this procedure is more complex than primary TKA.