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

Listen to Simon and Amy discuss the paper 'The requirement for total knee arthroplasty following surgical fixation of tibial plateau fractures' published in the December 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're discussing the paper, 'The requirement for total knee arthroplasty following surgical fixation of tibial plateau fractures', published in December, 2025 by M Strafford, M Biddle, and B Rooney. I'm Simon and I'm joined by my co-host, Amy.

Hello Simon, delighted to be here. This paper tackles a significant topic in orthopaedic surgery. The occurrence and outcomes of total knee arthroplasty or TKA following surgical fixation of tibial plateau fractures. These fractures while forming only 1% of all fractures present notable challenges due to their complexity.

The established method for managing these fractures is open reduction and internal fixation or ORIF. However, a frequent complication post-procedure is post-traumatic osteoarthritis, which may eventually lead to a TKA.

Precisely and the study aimed to assess the rate of TKA following ORIF for these [00:01:00] fractures. The primary outcome measured was the incidence of periprosthetic joint infection or PJI with secondary outcomes focusing on patient function post-surgery.

For their methods, the researchers conducted a retrospective multicentre study over a 12 year period, identifying 854 patients with surgically managed tibial plateau fractures. Of these, 26 patients required a TKA, which is about 3.04% of the cohort.

The statistics are quite revealing. For instance, the rate of PJI among these patients was significantly higher at 11.54% compared to primary TKA, where the PJI rate was only 0.84%. The authors recommend a two-stage approach to reduce the PJI rate in complex cases.

They propose advising patients that the outcomes of TKA following fracture fixation are inferior to primary TKA. This is echoed by their findings that the Oxford Knee Scores were considerably lower for those needing TKA after tibial plateau fractures.

[00:02:00] Indeed, the increase in Oxford Knee Score averaged just 14.3 points for patients without PJI and a mere four points for those who developed PJI. This highlights the difficulty of achieving optimal patient-reported outcomes in such cases.

The study also examined factors influencing outcomes, including the Schatzker classification of the fracture, which correlates directly with prognosis and complication rates. They noted that higher grade injuries such as grade V and VI were more common among those who developed PJIs.

Yes, and the average time between the initial fracture fixation and subsequent TKA was also notable. It varied significantly with a mean of 36 months highlighting the chronic nature of the condition leading to TKA.

However, for those who developed PJI, the average was about 14.7 months. The study staged approach involves removing the metal work first and ensuring the infection is absent or resolved before proceeding with the TKA. This aims to reduce the high incidence of PJIs.

Additionally [00:03:00] the study reviewed the organisms responsible for infections, identifying S. aureus as a recurring culprit. This aligns with other studies on PJIs and underscores the need for targeted antibiotic prophylaxis. And let's not forget the personal toll on patients. The study reported severe outcomes, including chronic osteomyelitis and even above knee amputation in some cases, which underscores the seriousness of PJI's post-TKA, and the importance of meticulous surgical planning and patient counseling.

In summary, this study highlights the complicated interplay between tibial plateau fractures, subsequent ORIF, and the eventual need for TKA. The heightened risk of PJI in these cases necessitates a careful multi-stage approach to improve outcomes and manage patient expectations realistically.

Absolutely Amy, it's been a thorough discussion today on AI talks with Bone & Joint. Thanks for tuning in everyone. Remember to check out the full study by Strafford, Biddle, and Rooney in Bone & Joint [00:04:00] Open. See you in the next episode.