The requirement for total knee arthroplasty following surgical fixation of tibial plateau fractures

Aims Tibial plateau fractures comprise 1% of all fractures, with a gold standard management of open reduction and internal fixation. Post-traumatic osteoarthritis is a common complication following fixation that can result in the requirement of a total knee arthroplasty (TKA). This study was designed to review the rate of TKA following surgical fixation of tibial plateau fractures. Primary outcome was the incidence of periprosthetic joint infection (PJI) and secondary outcome was function in these patients. Methods This retrospective multicentre study identified all patients with tibial plateau fractures that underwent surgical fixation within our health board over a 12-year period. The patients who then went on to require a TKA were identified. Results Between May 2008 and May 2021, 854 patients had a tibial plateau fracture managed surgically. Of these, 26 patients (3.04%; 1.89% to 4.20%) went on to require a TKA. Three of the 26 patients (11.54%; -0.74% to 23.82%) developed a PJI. The average increase in Oxford Knee Score was 14.3 for patients who did not go on to develop a PJI, compared with an increase of only 4 points in those that did develop a PJI. All patients in our study who had a TKA following fracture fixation had reduced postoperative patient-reported outcome measures when correlated to those reported in National Joint Registry data nationally for patients following both primary and revision TKA. Conclusion The rate of TKA following tibial plateau fracture fixation reflected that in the literature. The rate of PJI in our patients who had a TKA following a tibial plateau fracture fixation was found to be significantly higher (p < 0.0001) when compared with primary TKA. In an attempt to reduce the rate of PJI, we advocate for a two-stage approach in these patients. Patients should be counselled that the results of TKA following fracture fixation are inferior to primary TKA. Cite this article: Bone Jt Open 2025;6(12):1575–1580.