A Systematic Review and Meta-Analysis of Total Knee Arthroplasty after Tibial Plateau Fracture Fixation

Introduction: Tibial plateau fractures are common injuries that pose a significant risk of post-traumatic osteoarthritis (PTOA) despite surgical fixation. Though total knee arthroplasty (TKA) has been proven as a viable treatment option for PTOA, there is a higher risk of postoperative complications in patients with prior tibial plateau fracture (TPF). This systematic review aimed to evaluate surgical considerations and outcomes of TKA in patients with prior TPF fixation. Methods: A search of PubMed MEDLINE, Embase, and Scopus databases from January 2008 to July 2023 was performed according to PRISMA guidelines using the following inclusion criteria: TPF, PTOA, TKA, and conversion TKA. Exclusion criteria included periprosthetic fractures, distal femoral fractures, and patients under 18. Two independent reviewers screened each study. For postoperative infection and revision rates, the results were pooled, and random-effects meta-analysis of single proportions was conducted to determine combined rate of infections and revisions. Results: 9 studies involving a total of 572 patients who underwent TKA following TPF fixation were included. Average patient age ranged from 44.0 to 65.7 years, with mean TPF-to-TKA intervals from 1.7 to 13.6 years. TPF fixation details, implant types, and complication rates, including infection (range 3.2%-36.8%) and revision (range 0%-20%), were reported in most studies. The meta-analysis pooled estimates for postoperative infection and revision rates were 11% (95% CI 0.06-0.16) at an average of 7.0 years follow-up and 9% (95% CI 0.04-0.15) at an average of 7.4 years follow-up. Conclusion: TKA in patients with previous TPF fixation can be complex and may require augments and increased implant constraint. Though the literature reports good functional outcomes in this TKA population, TKA after TPF fixation carries increased risk of both infection and aseptic revision compared to patients undergoing TKA for osteoarthritis. Further high-quality prospective studies are needed to elucidate risk factors and optimize management strategies for patients undergoing TKA following TPF fixation.