The Role of Immediate Arthroplasty in Elderly Tibial Plateau Fractures.

Introduction/background: Complex articular fractures around the knee in the elderly patient present an ongoing challenge regarding optimal treatment. While extensive research has evaluated immediate arthroplasty following fracture of the proximal femur, distal femur, proximal humerus, and elbow, relatively little focus has been given to immediate arthroplasty following complex tibia plateau fractures.

Methods: As seen with many other fractures, arthroplasty can shorten recovery and hospital stay and allow early weight-bearing with improved mobility while minimizing complications and possible future conversion arthroplasty cost. Notably, total knee arthroplasty (TKA) in the setting of post-traumatic arthritis has demonstrated worse outcomes when compared to TKA for osteoarthritis. Further, increased complication rates have been reported when TKA is performed following failed open reduction internal fixation compared to TKA for acute fracture.

Conclusion: Potential candidates for acute arthroplasty include the elderly patient with pre-existing degenerative joint disease, poor bone quality, complex articular fractures, inability to comply with weight-bearing restrictions, and cases where additional procedures may be poorly tolerated. When choosing arthroplasty, the principles of revision joint arthroplasty and implant selection remain critical. Meticulous preoperative planning, multidisciplinary perioperative management, and a well-executed technique are essential when performing arthroplasty for acute tibial plateau fractures in the elderly.