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Functional outcome of total knee arthroplasty following tibial plateau fractures: a systematic review

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Posttraumatic osteoarthritis (PTOA) following a tibial plateau fracture (TPF) is a debilitating disease which often affects a young and active patient population for whom good knee function is essential. Frequently, total knee arthroplasty (TKA) is the only surgical option. The aim of this systematic review was to evaluate functional outcome for TKA in PTOA patients, together with several secondary outcome parameters.

Methods

A systematic review according to the PRISMA guidelines was conducted. Studies were included that reported on patient-reported outcome measures, range of motion or objective functional analysis after TKA because of PTOA following TPF.

Results

After analyzing 105 studies, 5 were included for the final review. In total, 162 patients with a TKA for PTOA were included of whom 125 (77%) were managed operatively for their TPF. All studies reported improvements in functional outcome after TKA, with two studies showing no significant differences between PTOA patients and a matched cohort of primary OA patients. Reported complication and re-intervention rates were higher for TKA patients with PTOA.

Conclusion

The results of this review indicate the TKA for PTOA after a TPF provides satisfactory functional outcome, with results similar to those of matched primary OA patients. TKA should, therefore, be considered a viable treatment option to improve function, but both patients and orthopedic surgeons should be aware of the higher complication rates in this patient population.

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Funding

No funding was received to assist with the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All the authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

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Authors and Affiliations

  1. CORAL – Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands

    Pieter Pander, Bas Lennart Fransen, Frans Johan Alexander Hagemans & Lucien Cornelis Marie Keijser

Authors
  1. Pieter Pander
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  2. Bas Lennart Fransen
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  3. Frans Johan Alexander Hagemans
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  4. Lucien Cornelis Marie Keijser
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Corresponding author

Correspondence to Pieter Pander.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. No funds, grants, or other support was received.

Ethical approval

This is a systematic review. No ethical approval is required.

Informed consent

This is a systematic review. Informed consent is not required.

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Appendices

Appendix A Search string

((((“Osteoarthritis, Knee”[Mesh] OR Knee Osteoarthritis* [tiab] OR Posttraumatic Osteoarthritis* [tiab] OR Osteoarthritis* [tiab] OR Traumatic Arthritis* [tiab]))) AND ((“Arthroplasty, Replacement, Knee”[Mesh] OR Knee Replacement Arthroplast* [tiab] OR Arthroplast* [tiab] OR Total Knee Arthroplast* [tiab] OR Total Knee Replacement* [tiab] OR Knee Arthroplast* [tiab] OR TKA* [tiab] OR Joint Replacement* [tiab]))) AND ((“Tibial Fractures”[Mesh] OR Tibial Fracture* [tiab] OR “Tibial Fracture” [Mesh] OR Tibial Plateau Fracture* [tiab])).

Appendix B Methodological items for non-randomized studies score (MINORS)

 

Author

Civinini

Lizaur

Saleh

Scott

Weiss

1

A clearly stated aim

The question addressed should be precise and relevant in the light of available literature

1

2

1

2

2

2

Inclusion of consecutive patients

All patients potentially fit for inclusion (satisfying the criteria for inclusion) have been included in the study during the study period (no exclusion or details about the reasons for exclusion)

2

2

2

2

2

3

Prospective collection of data

Data were collected according to a protocol established before the beginning of the study

0

2

1

2

2

4

Endpoints appropriate to the aim of the study

Unambiguous explanation of the criteria used to evaluate the main outcome which should be in accordance with the question addressed by the study. In addition, the endpoints should be assessed on an intention-to-treat basis

2

2

1

2

2

5

Unbiased assessment of the study endpoint

Blind evaluation of objective endpoints and double-blind evaluation of subjective endpoints. Otherwise the reasons for not blinding should be stated

0

1

0

0

0

6

Follow-up period appropriate to the aim of the study

The follow-up should be sufficiently long to allow the assessment of the main endpoint and possible adverse events

2

2

2

2

2

7

Loss to follow-up less than 5%

All patients should be included in the follow-up. Otherwise, the proportion lost to follow-up should not exceed the proportion experiencing the major endpoint

1

2

2

2

1

8

Prospective calculation of the study size

Information of the size of detectable difference of interest with a calculation of 95% confidence interval, according to the expected incidence of the outcome event, and information about the level for statistical significance and estimates of power when comparing the outcomes

0

1

0

1

0

 

Additional criteria in the case of comparative study

9

An adequate control group

Having a gold-standard diagnostic test or therapeutic intervention recognized as the optimal intervention according to the available published data

n/a

2

n/a

2

n/a

10

Contemporary groups

Control and studied group should be managed during the same time period (no historical comparison)

n/a

2

n/a

1

n/a

11

Baseline equivalence of groups

The groups should be similar regarding the criteria other than the studied endpoints. Absence of confounding factors that could bias the interpretation of the results

n/a

2

n/a

2

n/a

12

Adequate statistical analyses

Whether the statistics were in accordance with the type of study with calculation of confidence intervals or relative risk

n/a

2

n/a

2

n/a

 

Total

8/16

22/24

9/16

20/24

11/16

 

Percentages

50%

92%

56%

83%

69%

  1. The items are scored 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). The global ideal score being 16 for non-comparative studies and 24 for comparative studies

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Pander, P., Fransen, B.L., Hagemans, F.J.A. et al. Functional outcome of total knee arthroplasty following tibial plateau fractures: a systematic review. Arch Orthop Trauma Surg 143, 1265–1274 (2023). https://doi.org/10.1007/s00402-021-04188-1

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